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NEW ORLEANS 


MEDICAL AND SURGICAL 
JOURNAL 

Volume Eighty-Four 


JULY, 1931 

TO 

JUNE, 1932 

(Inclusive) 


WETZEL PRINTING, Inc. 


720-726 Perdido' Street 


NEW ORLEANS 

Medical and Surgical journal 

Established 18 UU 


Published by the Louisiana State Medical Society 
under the jurisdiction of the following named 
Journal Committee: 


Roy B. Harrison, M. D., Ex-Officio 
For one year: John A. Lanford, M. D. 

For two years: S. M. Blackshear, M. D. 

H. W. Kostmayer, M. D., Chairman 
For three years: W. H. Seemann, M. D., 
Randolph Lyons, M. D., Secretary 


EDITORIAL STAFF 

John H. Musser, M. D Editor-in-Chief 

Leon S. Lippincott, M. D Editor 

Willard R. Wirth, M. D Editor 

H. Theodore Simon, M. D Associate Editor 

G. C. Anderson, M. D Associate Editor 

Jacob S. Ullman, M. D Associate Editor 

D. W. Jones, M. D Associate Editor 

COLLABORATORS— COUNCILORS 
For Louisiana For Mississippi 

H. E. Bernadas, M. D. J. W. Lucas, M. D. 
Daniel L. Silverman, M.D. L. L. Minor, M. D. 

C. C. DeGravelles, M. D. Jf. W. Robertson, M D. 

W. H. Browning, M. D. Thomas J Brown, M. D. 
T „ v T-w Willie H. Watson, M. D. 

J. B. Vaughan, M. D. H Lowry Rush> M D 

J. H. Slaughter, M. D_^ j os . g. Green, M. D. 

D. C. lies, M. D. W. H. Frizell, M. D. 

J. H. Landrum, M. D. D. J. Williams, M. D. 


Paul T. Talbot, M. D General Manager 

1430 Tulane Avenue 

SUBSCRIPTION TERMS: $3.00 per year in 

advance, postage paid, for the United States; $ 3.50 
per year for all foreign countries belonging to the 
Postal Union. 

News material for publication should be received 
not later than the twentieth of the month preced- 
ing publication. Orders for reprints must be sent 
in duplicate when returning galley proof. 

The Journal does not hold itself responsible 
for statements made by any contributor. 

Manuscripts should be addressed to the Editor, 
1U30 Tulane Avenue, New Orleans, La. 


INDEX TO VOLUME EIGHTY-FOUR 

July, 1931 — June, 1932 
— A — 

Abdomen, right side, from a surgical standpoint, by Dr. Joseph F. Armstrong 871 

Abdominal conditions, acute, treatment of, by Dr. W. H. Parsons 749 

Abramson, Paul D., — Tattooing — a brief review of its history, pathology and methods of 

removal : 191 

Adams, J. C., — Medical treatment of sinus diseases complicated by eye disturbances 269 

Adams, Jas. M., — The standard treatment of malaria 379 

Address of welcome on behalf of the local profession, by Dr. Emmett Irwin 195 

Agranulocytic angina with case report, by Dr. S. F. Strain and Dr. B. B. O’Mara 34 

Agranulocytic angina, by Dr. C. L. Brown ..— 959 

Allergic diseases, with special reference to those involving the respiratory tract, by Dr. John 

P. Henry : 849 

Allergy, gastro-intestinal manifestations in, by Dr. B. G. Efron 540 

Alsobrook, H. B., — One thousand cases of uterine fibroids in the negro race 317 

Am I my brother’s keeper?, by Dr. Glenn J. Smith 531 

Anderson, Ross E., — Gastro-intestinal disturbances in infants caused from middle ear and mas- 
toid diseases 534 

Anderson, W. H., — The role of the general practitioner in modern medicine 180 

Anesthesia, spinal, the technic and indications for, by Dr. J. Gould Gardner 953 

Aneurysm, aortic, a discussion on the treatment by the method of jugulo-carotid anastomosis, 

by Dr. Rudolph Matas 448 

Aneurysm, aortic, formation of arteriovenous fistula for relief of sequelae of, by Dr. Ambrose 

H. Storck 440 

Angina, agranulocytic, by Dr. C. L. Brown 959 

Annual address, by Dr. S. C. Barrow 931 

Appendicitis, chronic, by Dr. E. R. Nobles 13 

Appendix, ruptured, and its management, by Dr. J. C. Willis •- 518 

Armstrong, Joseph F., — The right side of the abdomen from a surgical standpoint 871 

Arteriovenous fistula, formation of for relief of sequelae of aortic aneurysm, by Dr. Ambrose H. 

Storck 440 

Arthritis, chaulmoogra oil in the treatment of, by Dr. Paul A. Mcllhenny 182 

Avertin, use of as a basal anesthetic, by Dr. I. M. Gage and Dr. Alton Ochsner 239 

— B — 

Baptist Hospital, Mississippi State, Staff Meeting 898 

Baptist Hospital, Southern, Staff Meetings 479, 558, 713, 811 

Barksdale, J. W., — Induced paralysis of the diaphragm, by Dr. J. W. Barksdale and Dr. S. F. 

Strain 753 

Barksdale, J. W., — Radium in the treatment of certain diseases of the uterus 326 

Barrow, S. C., — Response to address of welcome 197 

Barrow, S. C., — Annual address 931 

Battalora, G. C., — Non-union of fractures 879 

Beach, T. R., — Hypertension : I. 362 

Bertucci, Emile A., — Some observations with dichlorobenzine terpenolic compound vapor in 

hemoptysis | 620 

Bethea, Oscar W., — Inaccuracy of clinical thermometers 130 

Bethea, Oscar W., — Memorial service 235 

Biliary passage, congenital obstruction (atresia) of, with report of case, by Dr. H. Carroll 

McLeod 868 

Blood transfusion, by Dr. Samuel E. Field 764 

VBlum, Henry N., — Information that can be furnished by the opthalmologist 464 

Book Reviews 92, 160, 223, 307, 422, 509, 583, 659, 737, 839, 928, 992 

Bowie, E. R., — (joint author), — see Samuel, T. C : 760 

Brominol, emulsified light, pyelographic studies with, by Dr. W. A. Reed and Dr. W. F. 

Henderson 876 

Bronchography, by Dr. Victor M. Maxwell 549 


iv Index 

Brown, C. L., — Agranulocytic angina jjj 959 

Browne, Donovan C., — Headaches of gastro-intes tinal origin 680 

Bruns, H. Dickson, — A word concern h g Elliot’s tr ephine operation ■....: 671 

Buchanan, C. C., — Eye symptoms and changes resulting from sinus disease and treatment of 

same - - . 275 

Bullitt, James B., — State medicine — Annual Oration :..... 227 

Butler, Willis P., — The Louisiana criminal code relative to the functioning of the state lunacy 

commission . .... 795 

Butterv ii, W. W., — The widening horizon of child health 663 

Button, r stomosis, r.ew, for gastro-intestinal surgery, by Dr. J. T. Nix 332 

— C — 

Cancer oo tiol program, by Dr. J. W. Cox - 455 

Cancer of the skin, diagnosis and treatment of, by Dr. M. D. Ratcliff 550 

Cr m • r.mr.rch, newer developments in, by Dr. Charles F. Geschickter 95 

Caret ' ysician’s responsibility in the reduction of the mortality of, by Dr. Urban Maes .... 585 

Carciim;. .1 *' e lip, — radium treatment, by Dr. M. T. Van Studdiford 252 

Carroll, 0 F., — The uses of sodium ethyl-1 methyl-butyl-barbiturate (pentobarbital-sodium) 

in me 1 and surgery 375 

Case Repo . and Clinical Suggestions 39, 130, 198 

Chairmr:;’- /-ddress, by Dr. Lucien S. Gaudet 611 

Cha" er.ois, Fern, — The surgical treatment of sinus diseases complicated by eye disturbances.... 272 

Charity Hospital Medical Staff Meetings 557, 804, 887 

Charity Hospital, Natchez 204 

Charity Hospital, New Orleans, general staff meeting 479 

Charity Hospital Surgical Staff Meetings 556, 632, 711, 804, 887, 971 

Chaulmoogra oil in the treatment of arthritis, by Dr. Paul A. Mcllhenny 182 

Child health, widening horizon of, by Dr. W. W. Butterworth 663 

Clarke, Walter, — The burden of syphilis and gonorrhea in New Orleans 163 

Commission, lunacy, Louisiana criminal code relative to functioning of, by Dr. Willis P. Butler .... 795 
Congenital obstruction (atresia) of biliary pas • ;e with case report, by Dr. H. Carroll 

McLeod 868 

Correspondence from: 

Dr. Rudolph Matas •. 71 

Dr. T. A. Heath ...■ 71 

Dr. F. F. Young 148 

Cox, J. W., — The car.cer control program 455 

Crawford, J. A., — Granny magic J& 627 

Cully, John C., — Medical education in Mississippi 935 

Cystocele and prolapse, by Di. Hilliard E. Miller 687 

— D — 

Danna, Joseph A., — An example of what surgery can do in saving a certain group of cases of 

pulmonary tuberculosis as illustrated by a case report 513 

Dannreuther, Walter T., — The operative correction of uterine retrcdisplacements 311 

Diabetes and heart disease, by Dr. I. I. Lemann 612 

Diaphragm, induced paralysis of, by Dr. J. W. B rrhsdale and Dr. S. F. Strain 753 

Dichlorobenzine terpenolic compound vapor in hemoptysis, some observations, by Dr. Emile A. Ber- 

tucci x MR. 620 

Diphtheria immunization, newer conception of, by Dr. Robert A. Strong 743 

Diphtheria immunization, the economic phase in New Orleans, by Dr. John Signorelli 747 

Disability following fractures, by Dr. King Rand |H— 791 

Dislocations, recurrent, of the shoulder, by Dr. E. D. Fenner 1.... 607 

Diverticulitis of the colon with special reference to the sigmoid, by Dr. B. C. Garrett 5 

Douglas, Robt. G., — The modern methods of treatment of menigo-myelo-encephalitis 262 

— E — 

Editorials 51, 141, 202, 281, 391, 477, 554, 630, 709, 802, 885, 969 

Education, medical, in Mississippi, by Dr. John C. Culley P...... 935 

Efron, B. G., — Gastro-intestinal manifestations in allergy 540 

Elliot’s trephine operation, a word concerning, by Dr. H. Dickson Bruns 671 


Index 


v 


Encephalitis, menigo-myelo, modern methods of treatment, by Dr. Robt. G. Douglas 262 

Epilepsy, post-encephalitic, with a report of two cases in childhood, by Dr. Emile Naef 124 

Esophageal and gastric varices, by Dr. A. E. Gordin 865 

Evans, Joseph P., — The importance of prenatal care 545 

Eye injuries, industrial, by Dr. James B. Stanford 782 

Eye symptoms and changes resulting from sinus disease and treatment of same, by Dr. C. C. 

Buchanan 275 

F — 

Feet, painful, by Dr. Earl Hyman 861 

Fenner, E. D., — Acute and chronic osteomyelitis 105 

Fenner, E. D., — Recurrent dislocations of the shoulder 607 

Fever, undulant, a public health problem, by Dr. P. A. Kibbe 187 

Fibroids or pregnancy, by Dr. P. Graffagnino 589 

Fibroids, uterine, one thousand cases in the negro race, by Dr. H. B. Alsobrook 317 

Field, Samuel E., — Blood transfusion 764 

Finlay, R. C., — Roentgen ray examination of the stomach 625 

Fossier, A. E., — Doctor Frederick Loeber: 1839-1901 667 

Fossier, A. E., — The mariahuana menace 247 

Fractures, disability following, by Dr. King Rani 791 

Fractures, non-union of, by Dr. G. C. Battalora 879 

Fractures, patella, results of work done for past thirty-six years, with conclusions, by Dr. E. 

Denegre Martin 846 

French Hospital Staff Meetings 396, 482, 557, 635, 714, 811, 887 

— G — 

Gage, I. M., — -The use of avertin as a basal anesthetic, by Dr. I. M. Gage and Dr. Alton Ochs- 

ner 239 

Gardner, J. Gould, — The technic and indications for spinal anesthesia 953 

Garrett, B. C., — Diverticulitis of the colon with special reference to the sigmoid 5 

Gastric and esophageal varices, by Dr. A. E. Gordin „ 865 

Gastro-intestinal disturbances in infants caused from middle ear and mastoid diseases, by Dr. 

Ross E. Anderson 534 

Gastro-intestinal manifestations in allergy, by Dr. B. G. Efron 540 

Gastro-intestinal surgery, a new anastomosis button for, by Dr. J. T. Nix 332 

Gaudet, Lucien S., — Chairman’s address 611 

Geschickter, Charles F., — Newer developments in cancer research 95 

Goiter, use of iodine in, by Dr. E. R. Nobles 769 

Gonorrhea and syphilis, the burden of, in New Orleans, by Dr. Walter Clarke 163 

Gooch, John B., — The etiology and prognosis of sinusitis 966 

Googe, J. T., — Some of the problems challenging the doctors and health officers in Mississippi .. 178 

Gordin, A. E., — Esophageal and gastric varices 865 

Gordon, R. L., — Early syphilis: its diagnosis and treatment , 788 

Graffagnino, P., — Pregnancy or fibroids 589 

Granny magic, by Dr. J. A. Crawford . 627 

Guthrie, J. Birney, — The diagnosis and significance of splenic enlargement 340 

Gynecology, conservative, its rationale and its end results, by Dr. C. Jeff Miller 117 

— H — 

Harris, William H., — Experimental typhoid fever with consideration of toxins and endotoxins .. 1 

Hay fever a specialty, by Dr. W. P. Lambeth ~ 23 

Headaches of gastro-intestinal origin, by Dr. Donovan C. Browne 680 

Health work, county, appraisal of, based on reduction of morbidity and mortality, by Dr. Felix 

J. Underwood 174 

Heart disease and the diabetic, by Dr. I. I. Lemann 612 

Hebert, L. A., — Bacteriology and pathology of unlulant fever 259 

Hemoptysis, some observations with dichlorobenzine terpenolic compound vapor in, by Dr. Emile 

A. Bertucci 620 

Henderson, W. F., — (joint author), — see Reed, W. A 876 

Henry, John P., — Allergic diseases, with special reference to those involving the respiratory 

tract , 849 


VI 


Index 


History taking, by Dr. A. H. Little 388 

Hixon Memorial Hospital Staff Meetings 393, 482, 636 

Hobson, Sam, — Infectious mononucleosis 841 

Hospital Staff Transactions 53, 143, 204, 283, 393, 479, 556, 632, 711, 804, 887, 971 

Hotel Dieu Staff Meetings 58, 480, 633, 712, 806, 890, 976 

Hyman, Earl — Painful feet 861 

Hypertension, by Dr. T. R. Beach 362 

— I — 

Impotency, relation to verumontanitis, by Dr. L. B. Moseley 523 

Index, Schilling, by Dr. H. T'. Nicolle 114 

Industrial eye injuries, by Dr. James B. Stanford 782 

Iodin, use in goiter, by Dr. E. R. Nobles 769 

Irwin, Emmett, — Address of welcome on behalf of the local profession 195 

— K — 

Kibbe, P. A., — Undulant fever — a public health problem -».187 

Kimbell, Isham,— The practice of neuro-psychiatry in general hospitals 525 

King’s Daughters’ Hospital, Greenville 204, 558, 636, 714, 900, 972 

— L — 

Lacrymal apparatus, excretory portion, treatment of, by Dr. W. S. Sims 472 

Lady of the Lake Sanitarium Clinico-Pathological Meetings 56 

Lambeth W. P., — Hay fever a specialty 23 

LeDoux, Lucien A., — Senile vulvitis and vulvo-viginitis, with special reference to trichomo- 

nad vaginalis infection 121 

Lemann, I. I., — Heart disease and the diabetic........ ...1 612 

Little, A. H., — History taking 388 

Loeber, Dr. Frederick — 1839, 1901, by Dr. A. E. Fossier 667 

Looking into the future, by Dr. Alton Ochsner 945 

Lorio, Cecil, — A case of neurologic interest 198 

Louisiana criminal code relative to the functioning of the state lunacy commission, by Dr. Wil- 
lis P. Butler ......; 795 

Louisiana State Medical Society News .... 63, 146, 209, 288, 399, 488, 564, 640, 717, 814, 904, 980 
Lunacy commission, state, Louisiana criminal code relative to functioning of, by Dr. Willis P. 

Butler 795 

— M — 

Maes, Urban, — The physician’s responsibility in the reduction of the cancer mortality 585 

Malaria: cause, misdiagnosis, treatment and prevention, by Dr. G. H. Wood 31 

Malaria, the standard treatment of, by Dr. Jas. M. Adams 379 

Malignancy, roentgen ray in the diagnosis of, by Dr. E. C. Samuel and Dr. E. R. Bowie 760 

Mariahuana menace, by Dr. A. E. Fossier 247 

Marine Hospital, series of case reports from a clinical meeting -ip 39 

Martin, E. Denegre, — Results of work done on fractures of patella for past thirty-six years, 

with conclusions Wk. :. v ±gP846 

Mastoids, of infants, treatment of infections of when there is no sign of destruction present, 

with fractional doses of the roentgen rays, by Dr. Amedee Granger Ill 

Matas, Rudolph, — Noguchi, by Gustav Eckstein, a review 131 

Matas, Rudolph, — On the treatment of aortic aneurysm by the method of jugulo-carotid ana- 
stomosis: a discussion 448 

Mattingly, C. Walter, — Acute perforation of peptic ulcers 18 

Maxwell, Victor M., — Bronchography 547 

Medical education in Mississippi, by Dr. John C. Culley 935 

Memorial service, by Dr. Oscar W. Bethea §£$1 S... 235 

Menville, Leon J., — The diagnostic importance of roentgenology in medicine 674 

Middle ear and mastoid diseases, gastro-intestinal disturbances caused from, by Dr. Ross E. 

Anderson 534 

Miller, C. Jeff., — Conservative gynecology: its rationale and its end results 117 

Miller, Hilliard E., — Cystocele and prolapse 687 

Mississippi, some of the problems challenging the doctors and health officers in, by Dr. J. T. 

Googe II 178 


Index vii 

Mississippi State Baptist Hospital Staff Meeting- 974 

Mississippi State Hospital Stalf Meetings 53, 898 

Mississippi State Medical Association News 72, 149, 212, 294, 406, 494, 571, 645, 723, 820, 910, 985 

Mononucleosis, infectious, by Dr. Sam Hobson 841 

Monte, L. A., — (joint author), — see Musser J. H 475 

Moseley, L. B., — Verumontanitis: its relation to impotency 523 

Musser, J. H., — Abortive poliomyelitis, report of two cases by Dr. J. H. Musser and Dr. L. A. 

Monte 475 

Myeloma, multiple, report of a case, by Dr. Willard R. Wirth 698 

— Me — 

Mcllhenny, Paul A., — Chaulmoogra oil in the treatment of arthritis 182 

McLeod, H. Carroll, — Congenital obstruction (atresia) of biliary passage with report of case .. 868 
McMillan, Thomas M., — Rheumatic fever and rheumatic heart disease, by Dr. Thomas M. Mc- 
Millan and Dr. Charles F. Nichols 346 

— N — 

Naef, Emile, — Post-encephalitic epilepsy, with a report of two cases in childhood 124 

Neurological case of interest, by Dr. Cecil Lorio 198 

Neuro-psychiatry, practice in general hospitals, by Dr. Isham Kimbell 525 

Nichols, B. H., — Some observations on roentgenography of the skull 429 

Nicholle, H. T., — The Schilling index . 114 

Nichols, Charles F., — (joint author), — see McMillan, Thomas M 346 

Nix, J. T., — A new anastomosis button for gastro-intestinal surgery 332 

Nobles E. R., — Chronic appendicitis 13 

Nobles, E. R., — The use of iodine in goiter 769 

Noguchi, by Gustav Eckstein, a review, by Dr. Rudolph Matas 131 

— O — 

Ochsner, Alton, — Chronic cutaneous ulceration of the lower extremities 594 

Ochsner, Alton, — (joint author), see Gage I. M 239 

Ochsner, Alton, — Looking into the future 945 

O’Mara, B. B., — (joint author), see Strain S. F. 34 

Ophthalmologist, information that can be furnished by, by Dr. Henry N. Blum 464 

Orleans Parish Medical Society Transactions 61, 286, 396, 487, 562, 638, 715, 812, 901, 978 

Osteomyelitis, acute and chronic, by Dr. E. D. Fenner 105 

— P — 

Paralysis, induced, of the diaphragm, by Dr. J. W. Barksdale and Dr. S. F. Strain 753 

Parsons, W. H., — The treatment of certain acute abdominal conditions ....._. 749 

Patella, fractures, results of work done for past thirty-six years, with conclusions, by Dr. E. De- 

negre Martin 846 

Pentobarbital-sodium, sodium ethyl-1 methyl-butyl-barbiturate, in medicine and surgery, by Dr. 

George F. Carroll 375 

Physician’s responsibility in the reduction of the cancer mortality, by Dr. Urban Maes 585 

Plastic operation of the face, planning the, by Dr. H. Lowry Rush and Dr. Leslie V. Rush .... 948 

Pneumonia lobar, and its treatment, by Dr. E. L. Walker ... 369 

Poliomyelitis, abortive: report of two cases, by Drs. J. H. Musser and L. A. Monte 475 

Practitioner, general, the role of in modern medicine, by Dr. W. H. Anderson 180 

Pregnancy or fibroids, by Dr. P. Graffagnino 589 

Prenatal care, importance of, by Dr. Joseph P. Evans 545 

Problems, some challenging the doctors and health officers in Mississippi, by Dr. J. T. Googe .. 178 

Prolapse and cystocele, by Dr. Hilliard E. Miller 687 

Psychopathic personality, the problem of, by Dr. Geo. F. Roelirig 693 

Pyelographic studies with emulsified light brominol, by Dr. W. A. Reed and Dr. W. F. Hen- 
derson I 876 

Pyelonephritis occurring in pregnancy, by Dr. W. A. Reed 775 

— R — 

Radiology as a specialty of medicine, by Dr. George P. Sims 234 

Radium in the treatment of certain diseases of the uterus, by Dr. J. W. Barksdale 326 

Radium treatment of carcinoma of the lip, by Dr. M. T'. Van Studdiford 252 


Index 


viii 

Rand, King, — Disability following fractures 791 

Ratcliff, M. D., — The diagnosis and treatment of cancer of the skin 550 

Reed, W. A., — Pyelographic studies with emulsified light brominol, by Ds. W. A. Reed and W. 

F. Henderson - 876 

Reed, W. A., — Pyelonephritis occurring in pregnancy 775 

Response to address of welcome, by Dr. S. C. Barrow 197 

Reviews 131 

Rheumatic fever and rheumatic heart disease, by Dr. Thomas M. McMillan and Dr. Charles F. 

Nichols 346 

Robin, W. H., — Toxoid immunization campaign 741 

Roeling, Geo. F., — The problem of psychopathic personality 693 

Roentgenography of the skull, some observations, by Dr. B. H. Nichols 429 

Roentgenology in medicine, the diagnostic importance of, by Dr. Leon J. Menville 674 

Roentgen ray examination of the stomach, by Dr. R. C. Finlay 625 

Roentgen rays, fractional doses in the treatment of infections of the mastoids of infants, when 

there is no sign of destruction present, byDr. Amedee Granger Ill 

Roentgen ray in the diagnosis of malignancy, by Dr. E. C. Samuel and Dr. E. R. Bowie 760 

Roentgen ray treatment of inflammatory and non-malignant conditions, by Dr. E. B. Van 

Ness 757 

Ross, T. E., Jr., — Surgery in the prevention of disease 460 

Rush, H. Lowry, — Planning the plastic operation of the face, by Dr. H. Lowry Rush and Dr. 

Leslie V. Rush 948 

Rush, Leslie V., — (joint author), — see Rush H. Lowry 948 

Rush’s Infirmary Staff Meeting 486 

— S — 

Samuel, E. C., — The roentgen ray in the diagnosis of malignancy, by Dr. E. C. Samuel and Dr. 

E. R. Bowie 760 

Schilling index, by Dr. H. T. Nicolle 114 

Shoulder, recurrent dislocations of, by Dr. E. D. Fenner 607 

Signorelli, John, — The economic phase of diphtheria immunization in New Orleans 747 

Sims, George P., — Radiology as a specialty of medicine s 234 

Sims, W. S., — The treatment of the excretory portion of the lacrymal apparatus 472 

Sinus diseases complicated by .eye disturbances, medical treatment of, by Dr. J. C. Adams .... 269 
Sinus diseases complicated by eye disturbances, surgical treatment of, by Dr. Fern Champe- 

nois :. 272 

Sinusitis, the etiology and prognosis of, by Dr. John B. Gooch 966 

Skull, roentgenography of, by Dr. B. H. Nichols 429 

Smith, Glenn J., — Am I my brother’s keeper? 531 

Sodium ethyl-1 methyl-butyl-bartiburate (pentobarbital-sodium) in medicine and surgery, by 

Dr. George F. Carroll 375 

Southern Medical Association .>1^ 427 

Spinal anesthesia, the technic and indications for, by Dr. J. Gould Gardner .....' 953 

Splenic enlargement, the diagnosis and significance of, by Dr. J. Birney Guthrie 340 

Stanford, James B., — Industrial eye injuries 782 

State Medicine — Annual Oration, by Dr. James B. Bullitt „... 227 

Stomach, roentgen ray examination of, by Dr. R. C. Finlay 625 

Storck, Ambrose H., — Formation of arteriovenous fistula for relief of sequelae of aortic aneu- 
rysm | 440 

Strain, S. F., — Agranlucocytic angina with case report, by Dr. C. F. Strain and Dr. B. B. 

O’Mara 34 

Strain, S. F., — (joint author), see Barksdale, J. W 753 

Strong, Robert A., — The newer conception of diphtheria immunization 743 

Surgery — an example of what surgery can do in saving a certain group of cases of pulmonary 

tuberculosis as illustrated by a case report, by Dr. Joseph A. Danna 513 

Surgery in the prevention of disease, by Dr. T. E. Ross, Jr 460 

Syphilis and gonorrhea, the burden of, in New -Orleans, by Dr. Walter Clarke 163 

Syphilis early, its diagnosis and treatment, by Dr. R. L. Gordon 788 


Index 


IX 


— T — 

Tattooing- — a brief review of its history, pathology and methods of removal, by Dr. Paul D. 

Abramson . - - 191 

Thermometers, clinical, inaccuracy of, by Dr. Os^ar W. Bethea 130 

Toomer, W. A., — Home treatment of tuberculosis 357 

Touro Infirmary Staff Meeting 890 

Toxoid immunization campaign, by Dr. W. H. Robin 741 

Transfusion, blood, by Dr. Samuel E. Field . 764 

Trichomonad vaginalis infection, and senile vulvitis and vulvo-vaginitis, by Dr. Lucien A. 

LeDoux 121 

Tuberculosis, home treatment, by Dr. W. A. Toomer 357 

Tuberculosis, pulmonary — an example of what surgery can do in saving a certain group of 

cases of pulmonary tuberculosis as illustrated by a case report, by Dr. Joseph A. Danna 513 

Typhoid fever, experimental, with consideration of toxins and endotoxins, by Dr. William H. 

Harris 1 

— U — 

Ulceration, chronic cutaneous, of the lower extremities, by Dr. Alton Ochsner ... 594 

Ulcers, peptic, acute perforation of, by Dr. C. Walter Mattingly 18 

Underwood, Felix J., — Appraisal of county health work based on reduction of morbidity and 

mortality 174 

Undulant fever — a public health problem, by Dr. P. A. Kibbe 187 

Undulant fever, bacteriology and pathology, by Dr. L. A. Hebert 259 

Urinary lesions, non-urologic symptoms due to, by Dr. E. Weiner 28 

Uterine fibroids, one thousand cases in the negro race, by Dr. H. B. Alsobrook 317 

Uterine retrodisplacements, operative correction of, by Dr. Walter T. Dannreuther 311 

Utero-salpingorraphy with lipiodol, by Dr. J. P. Wall 329 

Uterus, radium in the treatment of certain diseases of, by Dr. J. W. Barksdale 326 

— V — 

Van Studdiford, M. T., — Carcinoma of the lip — radium treatment 252 

Van Ness, E. B., — The roentgen ray treatment of inflammatory and non-malignant conditions .... 757 

Varices, esophageal and gastric, by Dr. A. E. Gordin 865 

Verumontanitis: its relation to impotency, by Dr. L. B. Moseley 523 

Vicksburg Hospital Staff Meetings 144, 283, 807, 895 

Vicksburg Sanitarium 714 

Vicksburg Sanitarium and Crawford Street Hospital Staff 

Meetings 54, 143, 205, 284, 394, 483, 559, 635, 808, 892, 974 

Vulvitis and vulvo-vaginitis, senile, with special reference to trichomonad vaginalis infection, 

by Dr. Lucien A. Ledoux 121 

— W — 

Walker, E. L., — Lobar pneumonia and its treatment I 369 

Wall, J. P., — Utero-salpingorraphy with lipiodol 329 

Weiner, E., — Non-urologic symptoms due to urinary lesions : 28 

Willis, J. C., — The ruptured appendix and its management 518 

Wirth, Willard R., — Multiple myeloma — report of a case 698 

Wood, G. H., — Malaria: cause, misdiagnosis, treatment and prevention 31 



New Orleans Medical 

and 

Surgical Journal 

Vol. 84 JULY, 1931 • No. 1 


EXPERIMENTAL TYPHOID FEVER 
WITH CONSIDERATION OF TOXINS 
AND ENDOTOXINS.* 

WILLIAM H. HARRIS, M. D., 

New Orleans. 

(From the Department of Pathology and Bacte- 
riology, Tulane University.) 

The reproduction of typhoid fever by 
feeding Bacillus typhosus to anthropoid 
apes has been carried out with some degree 
of success by Greenbaum 1 and Metchinoff 
and Besredka. 2 Positive blood cudtures, 
agglutination reactions, lesions of Peyer’s 
patches and certain other features of the 
disease have been obtained. Feeding and 
inoculation experiments in smaller labora- 
tory animals as performed by Besredka, 3 
Sedan and Herrmann 4 and Gory and 
Dalsace 5 have met with but little if any 
success. A more protracted infection or 
septicemia has been produced but the le- 
sions resulting do not conform with those 
of human typhoid, presenting rather the 
aspects of an ordinary pyogenic invasion. 

The feature of greatest interest to the 
writer is the study of the toxic factor of 
the typhoid bacillus. Much work has been 
carried out upon this phase of the subject 
and a general review of the pertinent 
literature is to be found in the work of 
Gay. 6 There are those who hold that the 
poison is an endotoxin or one contained 
within the micro-organism and others who 
take the view that it is an ectotoxin, 

*Read before Orleans Parish Medical Society, 
October 13, 1930. 


elaborated in the cell and emanating to the 
surrounding structures. In any event 
there is some poisonous factor attribut- 
able to the activities of the typhoid bacillus 
which brings about the characteristic le- 
sions and accounts for the clinical evi- 
dences of toxemia as manifested by the 
stupor or mental hebetude, the delirium, 
subsultus tendinum, and carphology. 

The prevalent opinion among workers 
in bacteriology is that the poison of the 
typhoid bacillus is an endotoxin in as 
much as no specific soluble or ectotoxin 
has ever been procured which is usually 
not difficult in micro-organisms producing 
such a type of toxin as the bacilli of 
diphtheria, tetanus, botulism and the like. 
On the other hand, in micro-arganisms 
that possess an endotoxin, the toxic factor 
is quite difficult to obtain as a specific 
moiety and in reality, several varieties of 
poisons are procurable, no one of which 
appears to be specifically or definitely re- 
lated to the disease. For example in scar- 
let fever Dochez and Stevens 7 state that at 
least two separate and distinct toxins were 
recovered by them from the so-called 
streptococcus of scarlet fever. While all 
are agreed that the ectotoxins or so-called 
soluble toxins are definite and specific 
poisons for their respective micro-organ- 
isms so much dissertation has arisen for 
the other group namely, the endotoxins 
that we have been for along time and are 
still at present in a maze of uncertainty 
as to their manner of producing injury to 
the host. Certain modern conceptions are 


2 


Harris — Typhoid Fever with Consideration of Toxins and Endotoxins 


that virulence varies reciprocally with re- 
sistance or immunity and that virulence is 
due to the excretion of endotoxins, aggres- 
sins, virulins, or anaphylatoxins and these 
products injure the defensive mechanisms 
of the host or interfere with their activi- 
ties upon bacteria. It has even been con- 
sidered that the electrophoretic charge or 
potential difference (P.D.) related to the 
agglutinability of a micro-organism may 
likewise be related to its virulence. Thus 
there is a tendency to consider that this 
so-called endotoxin of pathogenic bacteria 
really breaks down the resistant barriers 
of the host and thus produce disease. 
While we can appreciate that this in part 
may be true, nevertheless after protective 
mechanisms are broken down we must still 
have some destructive substance that pro- 
duces the injury, whether by interference 
with cell metabolism, bio-chemical action 
upon the cell itself, or any other method of 
producing morbidity. There is no inten- 
tion to enter into the consideration of 
toxoids, toxons, toxinase, protoxin and the 
like as these would have no special signifi- 
cance herein. 

It may be of interest to recount the 
various methods and devices by which 
various workers have attempted to obtain 
an endotoxic factor from the typhoid 
bacillus: Hahn subjected the organisms to 
a pressure of 400 atmospheres in a Buchner 
press, Macfadyen triturated the bacilli 
after freezing with liquid air, Besredka. 
used heat to 60° and dessication in vacuo, 
Vaughan extracted a 2 per cent sodium 
hydroxide in absolute alcohol at 78° C. and 
numerous other methods have also been 
employed. 

Since the in vitro or test tube efforts 
have, as a whole, proven futile in the pro- 
duction of specific endotoxins, there arises 
the question as to whether or not, these 
substances are only put in action when the 
micro-organism comes in contact with the 
living host. A classical representation of 
the liberation of a toxic moiety is shown 
in the Pfieffer phenomena. 


In this connection Duval 8 immunized 
rabbits against the streptococcus of scar- 
let fever and found that when a suspension 
of this micro-organism was introduced into 
the belly cavity of such immune animals a 
lysate was procured containing a toxic 
factor which when injected into animals 
produced glomerulo - nephritis and other 
aspects in accord with the toxic factor of 
this disease. Others working with this 
micro-organism in vitro have obtained no 
toxic factor that may be regarded as 
specific and the inoculation experiments 
into animals have yielded negative results. 

In the work undertaken by us 9 > 10 in 
connection with the typhoid bacillus, we 
simply produced an ordinary acute peri- 
tonitis by injecting a suspension of this 
micro-organism into the peritoneal cavity 
and then procured the fluid exudate present. 
This material was filtered through a 
Berkefeld filter and the filtrate injected 
into normal guinea-pigs. The inoculations 
were administered subcutaneously, intra- 
peritoneally and intracardially for separ- 
ate series of these animals. There resulted 
from these injections pyrexia, a marked 
leucopenia and in three or four weeks 
death occurred. The gross lesions found at 
post - mortem were enlarged lymphatic 
glands especially in the peritoneal cavity, 
softened and enlarged spleen, focal necro- 
sis of the liver and lesions of the solitary 
follicles and Peyer’s patches with superfi- 
cial ulcerations. The microscopic study of 
the lesions of Peyer’s patches and lymphoid 
structures presented a picture similar to 
that seen in human typhoid fever — namely, 
proliferation of endothelial cells presenting 
the aspect of the phagocytic cells of Mal- 
lory — which picture when generalized is 
regarded as pathognomonic of the disease. 
The focal necrosis of the liver present in 
the gross was confirmed microscopically 
and the spleen presented numerous shadow 
corpuseles outside and within the phago- 
cytic cells. Control experiments reported 
by us, 11 wherein B. coli was employed in 


Harris — Typhoid Fever with Consideration of Toxins and Endotoxins 


3 


a similar manner did not produce the same 
results. 

It would appear therefore that the toxic 
material obtained through this procedure is 
the same poison or toxin that produces the 
diseases in the human host. In connection 
with the toxic filtrate obtained, it is to be 
realized that so-called filtrable forms of 
B. typhosus and many other micro-organ- 
isms have been demonstrated. Hadley, in 
a. personal communication, has suggested 
that the lesions produced by us may be 
due to filtrable forms. We can see no 
reason for ascribing to a filtrable form of 
B. typhosus a specific capacity per se 
that the micro-organism proper does not 
possess. Again, since such forms are filter- 
able as are the toxic elements, it would be 
difficult to separate their activities except- 
ing by several generations of growth of 
the filterable forms. In fact, after we 
consider the potentiality of the filterable 
forms, we are still confronted with the 
realization, that they, too, must possess 
some specific toxic factor. 

The regrettable feature of the work is 
that this toxic material is of a very weak 
titer, in as much as it is necessary to in- 
ject one of two c. c. at several periods in 
order to produce such lesions in the guinea- 
pig. In the instances of the toxins of 
tetanus or of diphtheria, an extremely 
small fraction of a cubic centimeter will 
kill a guinea-pig in a short period of time. 
This comparison is brought forward to 
show the impracticability of immunizing a 
large animal with the feeble toxin pro- 
duced by us from the typhoid bacillus. 
Efforts have been made to procure inten- 
sification or concentration, even resorting 
to bacteriophage introduction into the 
peritoneal cavity with the micro-organism 
but with no appreciable results. 

Such experiments point out the difficul- 
ties of procuring a satisfactory antitoxin 
for micro-organisms belonging to the en- 
dotoxic group. It serves to explain why 
the sera or antitoxins for pneumonia, 


scarlatina and various septicemas have 
met with but little success. Since no 
potent specific poison is obtainable from 
such micro-organisms no satisfactory anti- 
toxins can be produced. One would think 
that the production of lytic antibodies 
would be of great service but no striking 
results have been obtained through this 
measure. 

It is questionable as to whether or not 
a highly potent and specific toxin can be 
procured from micro-organisms of the endo- 
toxic group. It is also doubtful if the 
method of procedure would be the same for 
all, nevertheless, if such a process by some 
new method is discovered through research 
endeavors, we could expect the production 
of a most striking and useful augmentation 
in the field of sero-therapy. 

REFERENCES. 

1. Greenbaum, A. S. : Brit. Med. J., 1:817, 1904. 

2. Metchnikoff, E., and Besredka, A.: Ann. Inst. Pas- 
teur, 25:13, 1911. 

3. Besredka, A.: Local Immunization, Baltimore, 1927, 

p. 116. 


Sedan, 

J., 

and Herrmann, 

R. : 

Presse med. 

32 :403, 

Gory, 

M., 

and Dalsace, 

J.: 

Ann. Inst. 

Pasteur, 


40:194, 1926. 

6. Gay, F. P. : Typhoid Fever, New York, 1918, p. 31. 

7. Dochez, A. R., and Stevens, F. A. : J. Exper. Med., 
46:487, 1927. 

8. Duval, C. W„ and Hibbard, R. J. : J. Exper. Med., 

46:379, 1927. 

9. Harris, W. H. : Proc. Soc. Exper. Biol, and Med., 

25:372,. 1928. 

10. Harris, W. H., and Larimore, O. M.: J. Exper. 

Mel., 48:885, 1928. 

11. Harris, W. H., and Larimore, O. M. : Proc. Soc. 

Exper. Biol, and Med. 25 :528, 1928. 

DISCUSSION. 

Dr. C. W. Duval (New Orleans) : I listened 

with a great deal of interest to Dr. Harris’ very 
excellent dissertation on experimental typhoid 
fever, and particularly what he said about toxins 
and endotoxins. Of course, it is hard for me to 
add to his paper. It is with considerable trepi- 
dation that I open the discussion because of my 
ignorance of the nature of the toxic principle in 
typhoid. 

Dr. Harris has shown us photomicrographs of 
the experimental lesions of typhoid fever. He did 
not stress enough, however, that these correspond 


4 


Harris — Typhoid Fever with Consideration of Toxins and Endotoxins 


completely with the lesions produced in man by 
typhoid fever. I would say there is a complete 
correspondence. There is no lesion that we see 
in man, unless it be the “rose spot” that Dr. 
Harris has not induced in the experimental 
animal by means of what he regards as the 
endotoxin of the typhoid bacillus. 

This matter of bacterial endotoxins is of great 
interest to us all, and especially from the stand- 
point of specific serum therapy in certain of the 
infectious diseases of which typhoid fever be- 
longs. The infectious diseases are toxemias and 
should be considered under two groups: (1) those 
that are caused by germs elaborating a soluble 
toxin, and (2) those that are caused by so-called 
endotoxin, which is a poison held within the 
cytoplasm of the living micro-organism. It is 
with diseases that are caused by micro-organisms 
that elaborate a soluble toxin that we are able to 
benefit with immune serum therapy, as for ex- 
ample diphtheria. Diseases caused by micro- 
organisms that elaborate no soluble toxins but 
produce the disease through endotoxins, we have 
not been successful with specific serum treatment. 
This then is one of the knotty problems that 
immunologists are confronted with at the present 
time. Until we find out something more about 
the nature of endotoxins we cannot hope to do 
much in the cure of the prevention of disease by 
means of specific serum therapy. 

Just what are endotoxins? Certainly in the 
ordinary sense they are unlike bacterial toxins. 
It seems they are incapable of stimulating the 
body cells with the result that specific anti-toxins 
are produced such as we see for true toxins. 
Endotoxin undoubtedly stimulates the host cells to 
produce an antisubstance that is destructive to 
the responsible antigenic agent. Such an immune 
substance we speak of as lysin, and undoubtedly 
it is lysin that establishes the immunity in typhoid 
fever and keep us protected against subsequent 
attacks of the infection. In typhoid fever we see 
recovery and protection because of the production 
during the course of the disease of immune sub- 
stances. These anti substances have no toxin 
neutralizing effect in typhoid. In this disease 
we know that a toxic substance is extant in the 
patient but concerning it’s nature we are totally 
in the dark. For typhoid fever, Dr. Harris ex- 
plains, recovery is undoubtedly due to antibodies 
produced at the time of (;he infection and these 
remain after recovery, accounting thereby for the 
permanent immunity. Until we can induce ex- 
perimentally with typhoid antigen an anti-endo- 
toxin we cannot hope to know much about the 
nature of the specific poisons of B. typhosus. 


In conclusion, I would like to say that for 
typhoid and other “endotoxic” diseases that are 
produced by micro-organisms elaborating no solu- 
ble toxin, it is fairly certain that the respective 
poisons do not occasion in the infected host a 
specific neutralizing antibody. 

Dr. J. H. Musser (New Orleans) : There are 

one or two things I would like to find out from 
Dr. Harris in regard to this preparation. In the 
first place, is the toxin destroyed by heat? Does 
heat have any effect? I would like to know if 
he conceives of the disease typhoid fever being a 
disease which is primarily due to a toxin or 
whether produced by the organism itself? I 
would like to know what relation it bears to 
allergy. 

Dr. Harris (closing) : I do not not know that 

I will be able to answer very fully the inquiries 
of the various gentlemen. 

Dr. Duval has explained to a considerable ex- 
tent the method by which we think these indi- 
vidual get well. There is little doubt but that 
bacteriolysins play an important role in these 
recoveries. On the other hand, if we produce, as 
can be readily accomplished in lower animals, a 
bacteriolysin, by inoculation of the micro-organ- 
isms, we know that this particular serum when put 
into the human body does not cure the case. For 
example, to produce a bacteriolysin for B. diph- 
theriae is of no value therapeutically. 

Dr. Musser brought forth some extremely in- 
teresting features. The particular toxin we have 
is very unstable. It is destroyed by heat, it is 
thermolabile. The other question concerned the 
analogy between the manner in which the toxins 
of diphtheria or tetanus produce disease as com- 
pared with typhoid. Diphtheria and tetanus 
poisons are easily and readily formed; they are 
exotoxins. In typhoid the living host appears to 
play an important part in forming or liberating 
this particular toxin and it is then capable of 
giving rise to toxemia. 

Dr. Musser has also brought up the question 
of allergy. The phenomenon of allergy has, of 
course, entered greatly into the consideration of 
many reactionary occurrences. It represents the 
sensitization of the host with subsequent toxic 
reactions following the primary sensitization. 
Nevertheless, we must consider allergy as after 
all the result of some form of poison that is pro- 
duced whether secondarily or otherwise. 


Garrett — Diverticulis of the Colon with Special Reference to Sigmoid 


5 


DIVERTICULITIS OF THE COLON 

WITH SPECIAL REFERENCE TO 

THE SIGMOID.* 

B. C. GARRETT, M. D., 

Shreveport, La. 

This condition was first noticed by Vir- 
chow in the nineteenth centeury and some 
forty or fifty years later Grasser’s report 
and description of this disease made it 
much clearer to us, and later the extensive 
study of it by W. J. Mayo and his associates 
further cleared up the situation. Since that 
time practically all of the men writing on 
the subject agree on the method of handling 
it. I was disappointed in the small amount 
of space devoted to it in our present day 
text books. 

The reason for presenting this paper is 
primarily to learn more about this disease 
myself and to call the attention of the pro- 
fession to a condition or certain entity that 
we have in the past overlooked in a great 
many instances. It has been termed by 
some authors as left-handed appendicitis 
and the abdomen has been opened no few 
times for a ruptured appendix to find a 
normal appendix and, upon further explor- 
ation, a ruptured diverticulum of the sig- 
moid. I have been guilty of this myself 
and I am sure there are many other offend- 
ers. The usual symptoms that accompany 
this condition is no doubt familiar to all of 
us: pain, rigidity, temperature 100° to 104° 
F. and general abdominal distension and 
tympanites. The history given by these 
cases is one that is generally associated with 
chronic constipation and often times a coli- 
tis. It has probably never been proven be- 
yond a doubt that these conditions cause 
diverticulitis, but it is an evident fact that 
one or both of these conditions go hand in 
hand with diverticulitis. 

It might be well here to discuss what is 
generally accepted as the classification of 
this disease. First, the condition may be 


*Read before the Louisiana State Medical 
Society. Shreveport, April 29-May 1, 1930. 


congenital or acquired. The congenital 
diverticula are mostly confined to the small 
intestines, such as Meckle’s diverticulum 
and an occasional diverticulum of the duo- 
denum. I have under my observation now 
a case of diverticulum of the duodenum that 
has had three major abdominal operations, 
one in one of the best clinics in this country 
and the other two by good men, and the 
same symptoms prevail now as before those 
operations, and we only recently discovered 
it in our radiological study of her gastro- 
intestinal tract. This condition is rare, but 
we all know that we stumble upon Meckle’s 
diverticulum every now and then. The 
diverticulum of the small intestines, or the 
congenital types as we will speak of them, 
contain all three layers of the intestines, 
i. e., mucous membrane, muscular and 
serous coat. 

The diverticulum of the colon are com- 
monly called diverticulosis where there are 
several diverticulum of the colon in any 
part and are not causing any particular 
symptoms, and diverticulitis where there is 
any inflammation association with the 
diverticulum. It is conservatively esti- 
mated that about 85 per cent of diverticu- 
litis is confined to the sigmoid. 

I mentioned above diverticulosis or 
diverticula of the colon that were causing 
little or no trouble. Now I will speak of 
some of the complications of the disease. 
First of all, and one of most concern, 
is ruptured diverticulum. Of course here 
you are dealing with a very sick 
patient. The rupture usually occurs where 
the appendices epiloae come off from the 
intestines or where the artery enters the 
intestine. The two most plausible explana- 
tions for these two sites being the most 
common locations of rupture are : first, that 
fat replaces the muscle fibres in the first 
location, and that in the second instance 
the intestine wall is weakened where the 
vessel enters and allows the mucous mem- 
brane to push out at that site. The second 
complication is rupture of the diverticula 
and consequently burrowing through the 


6 


Garrett — Diverticulis of the Colon with Special Reference to Sigmoid 


scrotum or even through the perineal 
region with pus and fecal contents escaping 
through this sinus. 

Third, rupture into the bladder, which is 
not unusual. This happened to one of my 
own cases several days before she had been 
operated upon and drained. These openings 
into the bladder usually close of their own 
afccord, but sometimes have to be closed by 
operation later on after the acuteness of 
the condition has subsided. 

Fourth, abdominal abscess which is the 
result of ruptured diverticulum and which 
points to the left iliac fossa most of the 
time but might produce a pelvic abscess, 
or might, as stated above, burrow through 
the perineum. 

Fifth, obstruction of the bowels. This 
is a picture that most of us have faced to 
our sorrow. Usually a short fatty type of 
individual above fifty years of age is rushed 
into the hospital or sanitarium with this 
comphcation. This obstruction may be 
caused by several things, but most often by 
cicatricial tissue at the seat of the rupture 
of the diverticulum or by inflammation and 
edema of the affected parts. 

Sixth, lues should be considered as a pos- 
sible complication until ruled out by labor- 
atory and therapeutic test. 

Seventh, carcinoma of the sigmoid associ- 
ated with or as a complication of diverticu- 
litis. It has been shown that carcinoma is 
present in a small number of cases. Any 
case that passes blood from the rectum 
should be considered a possible case of car- 
cinoma, as an ordinary ruptured diverti- 
culum seldom ever causes the passage of 
blood, from the rectum. I might add here 
that it is not an easy task to tell whether 
carcinoma is present or not, even after the 
abdomen is opened. Often the tissue will 
look to be cancerous only to have a report 
come back from the laboratory “non-ma- 
lignant.” 

Diagnosis of these conditons as I see it 
depends upon first, the history of the case ; 


second, clinical symptoms; third, use of 
proctoscope, (but the mass is usually too 
high to be diagnosed by this means) ; and 
fourth, and most important, the roentgen- 
ray study of the case. We find the condi- 
tions in males as compared with females in 
a ratio of about three to one. Some cases 
have been reported in very young people, 
one case I believe in a child of seven years, 
but most of them are in people past middle 
life, and the average age of occurrence is 
past fifty years. 

It is thought that barium taken by mouth 
more often fill diverticula than when given 
by enema. Some of the leading radiolog- 
ists say that a plate taken two or three 
days after the original meal often shows 
diverticula that did not show on the original 
plate. The barium in the diverticula is the 
last to pass out. One should not be mislead 
by frustrations or pouches in the large in- 
testine and call them diverticula. Plebo- 
liths, gas bubbles, ureteral stones, and cal- 
cified glands are some other things that 
might be taken for diverticula. 

Treatment should be divided into two 
classes : first, treatment of the chronic cases 
of diverticulosis ; and second, treatment of 
the acute diverticulitis, ruptured or unrup- 
tured. 

The first class should be a matter of diet 
that causes as small an amount of residue 
as possible, colonic irrigations, regulation 
of bowels with mineral oil, etc. 

The second class, acute diverticulitis, I 
think should be treated conservatively. 
That is, rest in bed, ice cap to abdomen, 
enemas as indicated and proper diet. If 
an abscess forms it should be opened and 
drained and in the majority of those cases 
the diverticula will close without further 
treatment. This has been demonstrated 
by roentgen-ray study and laparotomy. One 
of my cases had ruptured into the bladder 
as stated above and an attempt was made 
to repair it but it was too friable to hold, 
and it evidently closed. In some rare cases. 


Garrett — Diverticulis of the Colon with Special Reference to Sigmoid 


7 


where there is obstruction a resection of a 
portion of the sigmoid should be done. Some 
cases might be done in one operation, but 
perhaps the method of choice would be the 
operation described by Mikulicz, first stage 
being to bring the intestine out of the cavity 
and fixing it according to his technic, and 
waiting two or three days if possible for the 
second stage or the resection. Side to side 
anastomosis should be considered in certain 
types of the obstructive cases where you 
have a sufficient loop of intestine to bring 
around the mass. 

In three of our cases resection with end 
to end anastomosis was done with the Mur- 
phy button. Two got well, one died, and 
one case was simply drained and she got 
well. The other one has not been operated 
on. 

CASE REPORTS. 

Case 1. Mr. M. T. F., white male, aged 46 
years, was admitted to the sanitarium April 18, 
1927 complaining of constipation and a mass in 
the lower left abdomen. The patient had been in 
good health for many years. However, eight years 
ago he had had a similar complaint which was 
relieved by a good copious bowel movement. He 
was frequently constipated and noticed some blood 
and mucus in the stools. For several months 
prior to the present illness he had had a slight 
hypertension with a low grade chronic nephritis. 
The present illness started three days prior to 
admission with constipation and the appearance 
of the mass in his side. Various laxatives and 
enemata gave very little relief. The general phy- 
sical examination revealed little of importance ex- 
cept a blood pressure of 150 systolic, 100 diastolic; 
a mass the size of a large orange in the lower left 
abdomen, and a slight trace of albumin in the 
urine. Operation was advised and on April 27, 
1927, the abdomen was opened with a left rectus 
incision. A growth on the sigmoid about the size 
of a man’s fist was exposed and dissected away 
from pelvic peritoneum. The growth was deliv- 
ered and about 8 inches resected between clamps. 
A Murphy button was applied, the edges covered 
over with chromic No. 2 sutures and the messen- 
tery attached over the gut. The omentum was 
brought down to where the button was put in. 
Cargile membrane was applied to the peritoneum 
where the mass was dissected. The wound was 
closed with chromic No. 2 and silk worm gut. 
After the growth was removed what looked to be a 
diverticulum was dissected out. Microscopic find- 
ings: Diverticulum with tuberculosis. 


Case 2. Mrs. W. A. K., entered the hospital 
May 2, 1926. She was a well developed white 
female of the short fatty type. Physical findings 
were essentially negative except for tenderness in 
the left side of the abdomen, which had bothered 
her for some weeks before entering the hospital. 
About every two or three weeks she said she 
would have to go to bed and stay in bed for two 
or three days. The onset usually came in with a 
slight rigor. She had been having these previous 
attacks for six or eight weeks before coming to 
the hospital. iShe thought that during the attack 
she usually had a little fever. Upon entering the 
hospital we saw a patient that had an acute 
abdominal distention, tymphanites and vomiting. 
Under general anesthesia through a mid-line in- 
cision we found a mass in the sigmoid that was 
producing an obstruction. This mass, which in- 
cluded from eight to twelve inches of the bowel, 
was resected and the ends brought together by 
means of a Murphy button. The wound was closed 
with chronic cat gut No. 2 and silk worm. Mic- 
roscopic findings on this tissue removed was a 
fibro-lipoma phlegmonous abscess and many plas- 
ma cells and eosenophils, some congestion, fibrini- 
ous exudate on the outside, not malignant. This 
operation was performed by a former associate of 
mine, Dr. Willis, and myself. Note: Further data 
on this case. Patient was readmitted to the hos- 
pital on December 7, 1926 for obstruction of the 
bowels. Upon opening the wound through which 
a post-operative hernia had developed, we found 
that the entire abdomen was filled with numerous 
adhesions and that the cecum had been pulled over 
to the region where the sigmoid had been resected. 
These adhesions were freed from the cecum and a 
band of adhesions that was caused by a piece of 
omentum was also freed from the sigmoid. The 
patient made an uneventful recovery. 

Case 3. Mrs. A. Q., Sr. entered the hospital 
June 6, 1928. She was a well developed white 
female, aged 55 years. Her present illness had 
begun May 17, with severe cramps in the abdomen. 
On May 18, the pain became less. She took a 
dose of castor oil and felt better after the castor 
oil acted. On May 19 and May 20 she felt weak 
but had very little pain. On May 20 she took a 
soapsud enema and while she was expelling the 
enema a sharp pain started in her abdomen and 
she bcemae very weak and cold. The pain lasted 
for three hours when morphine sulphate, grs.li 
was given. The pain stopped and the abdomen 
became very hard and distended. She felt a 
chilly sensation throughout her back and suffered 
tachycardia and felt very feverish. The doctors 
who were called in the case treated her for intes- 
tinal influenza. She gave no history of having 
passed blood from the rectum. However, she had 


Garrett — Diverticulis of the Colon with Special Reference to Sigmoid 


been constipated. On June 5, 1928, I was called 
in consultation and found a patient with a dis- 
tended abdomen with a history of frequent urin- 
ation, the urine containing much pus with 
a very foul odor. A pelvic examination was 
made and I found that the entire pelvis was one 
solid mass apparently more to the left than to 
the right side. The patient was brought to the 
sanitarium and under gas-ether anesthesia a mid- 
line incision was made. Upon opening the abdomen 
a ruptured diverticulum of the sigmoid was found 
which also had ruptured into the bladder, also an 
abscess in the pelvis which had a distinctive fecal 
odor. The appendix was mixed up in the general 
mass and was removed. The abdomen was drained 
by means of rubber tissue cigarette drains. Diag- 
nosis from the laboratory on the appendix was 
fibrosis and congestion. The patient’s abdomen 
was closed with drains as stated above. She had 
a rather stormy convalescence for a few days, but 
gradually got well and the opening in the bladder 
closed up within about three or four weeks time. 
Later on August 22, 1928 a fluoroscopic examina- 
tion showed the following: “Flouroscopic and plate 
observation of the colon, following the opaque 
enema, shows a partial obstruction in the sig- 
moid.” 

Case 4. Mrs. G. S., Sr. entered the sanitarium 
July 1, 1921 with a pre-operative .diagnosis of 
sarcoma of the sigmoid. The post-operative diag- 
nosis was the same at first, but later was changed 
to diverticulitis. ,She was a well developed fat 
female, 47 years of age. The past history was 
negative. She came into the sanitarium complain- 
ing of intense pain in lower left adbomen, more 
painful after her menstrual periods. 'The patient 
stated that this condition had existed for about six 
months, growing more pronounced and severe in 
character. She was subject to constipation, no 
urinary symptoms, appetite good, suffered with 
indigestion at times caused probably from indis- 
cretion in eating. The patient had had two oper- 
ations in her past life, one in 1910, perrinorrhaphy, 
and in 1913 had laparotomy, suspension of uterus 
and removal of ovarian cyst, and breaking up of 
adhesions. The appendix had not been removed. 
She had enjoyed good health all her life except 
for rheumatism in both knees and to a lessser de- 
gree in the hands. She had been maried at the age 
of 19 years and had one child 27 years old, healthy 
and normal. Menstruation started at 13 years 
of age, normal and regular. The heart and lungs 
were negative. The abdomen was very obese, and 
negative except for pain below the umbilicus in 
the lower left side, radiating upward. A vaginal 
examination revealed a mass in the region of the 
left ovary that was movable. There was some 
bloody discharge from the rectum. The patient’s 
abdomen was opened through a mid-line incision 


on July 1, 1921 and a mass in the sigmoid was 
found which was resected several inches in length 
by means of cautery. An end to end anastomosis 
was then done by means of a Murphy button. The 
abdomen was closed without drainage and the re- 
port from the laboratory, as stated above, was 
first fibro-lipo-sarcoma, spindle cell type, later 
changed to diverticulitis. The patient vomited 
for the first four or five days and after that got 
along nicely. On July 18, 1921 a flouroscopic ex- 
amination was made which showed the button still 
in the sigmoid. On the twenty-first day she passed 
the button. On November 15, 1921 about four 
months after she passed the button, another series 
of pictures was made on her and the following 
report rendered: “Roentgen-ray examination of 
the rectum, sigmoid and descending colon by enema 
method shows the rectum normal, sigmoid and 
descending colon constricted with serrated edges 
throughout.” Diagnosis: the above appearances 
indicate chronic inflammatory thickening of the 
intestinal wall non-malignant in nature. The 
patient today is up and well. This patient was 
operated upon by Dr. Willis, Sr. and myself. 

Case 5. Mr. F. A. B., aged 56 years, a white 
male complaining of intense cramp in the abdomen 
periodically — for a period pf several months. The 
patient was somewhat dissipated but had been 
in excellent health for many years. The present 
illness began in March, 1929, with cramoing pains 
in the intestines, seemingly distributed over the 
colon. There were evidences of an associated 
gastritis. The bowels were rather costive but 
no blood or mucus had been demonstrated. The 
general physical examination was that of an 
elderly white man well developed and nourished. 
The heart, lungs and extremities were normal, 
some tenderness distributed over the abdomen, 
apparentlv following the course of the descending 
colon. The laboratory examinations were irrele- 
vant. From the history and clinical records he 
was thought to have a diverticulitis. Roentgen- 
ray examination confirmed this, but instead of a 
single diverticulum there were numerous small 
diverticuli over the descending colon. He was 
advised as to diet and has had very little trouble 
since. 

BIBLIOGRAPHY. 

Haines, W. D. : Diverticulitis of the sigmoid, J. Med., 

Cincinnati, 8:377-383, 1927. 

Judd, E. Starr and Pollock, Lee W. : Diverticulitis of 

the colon. Ann. Surg., September, 1924, p. 425. 

Mailer, Robert: Diverticulitis of the sigmoid associated 

with tuberculosis. Am. J. Surg., 2:142-146, 1927. 

Masson, J. C. : Diverticulitis of the large bowel. Canad. 

M. Assn. J., February, 1921. 

Matthews, A. Aldridge: Diverticulitis of the sigmoid. 

Northwest Med., April, 1924. 


Garrett — Diverticulis of the Colon with Special Reference to Sigmoid 


9 


Mayo, William J. : Diverticulitis of the large intestine. 

J. A. M. A. 69:781-785, 1917. 

Mayo, William J. : Diverticulitis of the sigmoid. Vir- 

ginia M. Month, November, 1921. 

Mills, W. M.: Diverticulitis of the colon. J. Kansas M. 

Soc., 26:39-41, 1926. 

Noecker, Charles B. : Case reports : perforation of sig- 

moid and small bowel into uterus. Penn. M. J., 32:496, 1929. 

O’Callaghan, R. : Diverticulum of the ascending colon. 

Surg., Gynec. & Obst., 679-680, 1921. 

Overton, D. C. : Diverticulosis of the large bowel. Med. 

Clin. N. Am., 11:1361-1370, 1928. 

Patterson, Russell H. : Diverticulosis of the large in- 

testine. Am. J. Surg., 5:81-82, 1928. 

Pecfl, Charles H. : Diverticulitis of the colon. Ann. Surg., 

322-325, 1925. 

Porter, Miles F. : Enteroliths and diverticula, especially 

enteroliths contained in diverticula of the large bowel. 
Surg., Gynec. & Obst., August 185-186, 1925. 

Rankin, Fred W. & Judd, E. Starr.: Emphysema of the 

scrotum and the result of diverticulitis of the sigmoid with 
perforation. Surg., Gynec. & Obst., September 310-312, 1922. 

Sherrill, Alvan W. : Diverticulitis simulating carcinoma. 

Atlantic M. J., 30-165, 1926. 

Straub, George F. : Diverticulum of the descending colon 

causing hydronephrosis. Surg., Gynec. & Obst., 30:359- 
360, 1920. 

Ballin, Max. : Diverticulitis of the colon. Am. J. Surg., 

2:130-141, 1927. 

Barbat, J. Henry : Diverticulitis of the sigmoid : report 

of a case. Surg., Gynec. & Obst. 10:295-299, 1910. 

Carman, Russell D. : Report of a case of diverticulitis 

of the sigmoid, with the roentgenologic findings. Ann. Surg., 
61:343-348, 1915. 

Carman, R. D. : The roentgenologic findings in three 

cases of diverticulitis of the large bowel. Ann. Surg., 
March, 1915, p. 343. 

Case, James T. : Diagnosis and treatment of colonic 

diverticula. Am. J. Surg., 4:573-596, 1928. 

Chute, Arthur L. : Diverticulitis of the sigmoid as a 

source of bladder irritation. J. Urol., 21:13-21, 1929. 

Conley, H. P. : Diverticulosis of the colon. South. M. 

J., 18:503-506, 1925. 

De Quervain, F. : Diverticulitis of the large intestine. 

Practitioner, 118:352-360, 1927. 

Enfield, Charles D. : Diverticulosis and diverticulitis of 

the colon. Am. J. Roentgenol., 12:242-245, 1924. 

Enfield, Charles D. : Diverticulitis of the colon with 

special attention to diagnosis. Radiol., 7 :371-378, 1926. 

Erdmann, John F. : Diverticulitis of the colon. Am. J. 

Obst. & Gynec., 11:609-616, 1926. 

Gant, S. G. : Diverticula, diverticulitis and peridiverticu- 

litis ; of the small intestine, cecum, colon, sigmoid flexure 
and rectum. J. A. M. A., 77:1415-1420, 1921. 

Frank, Louis : Vagino-rectal aanomaly ; sigmoidal diver- 

ticulitis ; case reports. Kentucky M. J., 23:287-288, 1925. 

Thomas, W. S. & Jewett, C. Harvey. : Diverticula of the 

colon. Clifton M. Bull., 2, 1925. 

Veseen, L. V. : Diverticulitis of the sigmoid and rupture 

into the urinary bladder. J. Urol., 20:598-605, 1928. 


DISCUSSION. 

Dr. J. E. Heard (Shreveport) : Dr. Garrett 

has covered the main points of this important sub- 
ject very thoroughly, but there are a few little 
points I should like to touch on. 

This left-handed appendicitis is very much the 
same as an acute appendix. Unfortunately, we 
have one or more acute appendices to deal with. 
Colostomy is one of the main things to pull us 
out of the fire here. 

The thing I want to say a little about is the 
Mikulicz operation. The Mikulicz operation, as 
you all know, is usually a three-stage procedure. 
It doesn’t look as pretty as a straight resection, 
and it has its limitations because the mass must 
be mobilized to bring it outside the abdominal 
cavity. This cannot always be done. If it can 
not be done, we can do a colostomy. However, I 
believe the straight resection in this runs a high 
mortality. The mortality runs anywhere from 
fifteen to twenty per cent. I think it is a rather 
dangerous procedure, but it is always a tempta- 
tion, where we have the mass, to do a straight 
procedure and take it all out with an end-to-end 
anastomosis. 

There are a few little points about the opera- 
tion that it is well to bear in mind. (Blackboard 
drawing). With the Mikulicz operation, that is the 
abdominal wall, and you bring these loops of the 
intestine out like this, provided we can mobilize 
the tumor. That can usually be done by splitting 
the external leaf of the colon, and that does not 
interfere with the blood supply. With the Mikulicz 
operation we try to bring the tumor mass outside 
of the abdominal cavity. Be sure there are no 
pockets in the mesentery, with the intestine in- 
side. The reason is that we cut the intestine when 
we go to cut the shotgun double-barrelled sep- 
tum out. Use a rubber dam over this. The proxi- 
mal loop, if necessary, can immediately be punc- 
tured with a cautery (small tip) and, if neces- 
sary, I have done it a number of times, a large 
catheter can be put in there and drainage estab- 
lished immediately. After a few days, we take 
the actual cautery and lop it off flush with the 
skin. Do not cut it too close because the ends 
always retract and we do not want them down 
too low. 

Looking at it from the top, we have a double- 
barrelled shotgun right there. When these lips 
are brought together, you want to offset it so 
that the main blood supply is not on the center. 
If you do, you cut through the blood supply some- 
times and get a hemorrhage. Offset that a little 
bit. Then the clamp comes in here. They will 
sometimes close, but often it requires a third oper- 
ation to close these colostomy operations. 


10 


Garrett — Diverticulis of the Colon with Special Reference to Sigmoid 


Literally, the Mikulicz operation is a life saver, 
because it will save the mortality, although it is 
more or less long drawn out and requires two or 
three operations. It will save twelve per cent or 
better in mortality. 

Resections in these cases are very dangerous 
because of the inflammatory trouble. I think we 
should treat these acute cases much as we would 
acute appendicitis cases. I don’t think we should 
wait too long because if rupture is threatened 
you have a very much more serious condition to 
deal with. If you can go in soon enough, you 
can take care of this trouble here below. 

Dr. J. A. Hendrick (Shreveport, La.) : I will 
just take up the discussion of Dr. Garrett’s' paper 
from the standpoint of acute rupture. There is 
no doubt that too little is said in our text books 
and journals about this condition. 

We have had in the past few years five cases 
of acute ruptured diverticula of the sigmoid at 
the Highland 'Sanitarium. As Dr. Garrett said, 
it is not as rare an occurrence as our text books 
would lead us to believe. 

It is especially of prime importance to make a 
diagnosis in an acute ruptured diverticula of the 
sigmoid. There is a point in the history of 
these cases that we have seen that might be very 
important. Of course, in the acute ruptured 
diverticula of the sigmoid, we have the cardinal 
symrtoms of acute ruptured viscus, with severe 
onset of pain in the abdomen, tender board-like 
rigidity of muscles, increased pulse rate, the 
tragic shocked condition of the patient. We 
readily suspect a ruptured viscus. To definitely 
locate the rupture in the sigmoid is very difficult 
and not often done preoperative. The important 
point we get in taking the history which may be 
a lead to a correct diagnosis and which we found 
in four of our five cases was the onset of the 
acute abdominal pain while straining at stool. 
We can readily see why the rupture might occur 
at this time. With the walls of the diverticula 
very much thinned out, straining to empty the 
sigmoid which is filled with gas and fecal material 
with marked increase intra-sigmoidal pressure, 
makes the time ideal for a rupture. 

I am thoroughly of the opinion that if the 
diagnosis of a ruptured sigmoid can be definitely 
made, operative procedure is contraindicated un- 
less the case is seen very early. In our hand the 
only case in our series that recovered was one in 
which a diagnosis was not made until after the 
abscess had become definitely localized in lower 
left quadrant and was drained under local. 

We have a number of different types of in- 
flammatory diverticula. The one most often diag- 


nosed as a left-side appendicitis is small. We have 
seen a number of these. I think Dr. Garrett 
advised enemas. I know of one patient who had a 
small diverticula rupture while an enema was 
being given. We advise against enemas, especially 
during the acute stage. If an enema is given it 
should certain be very low pressure. 

If we will bear in mind the history of this 
condition: That it is usually in men about forty 

to fifty years old, rather stout, who have been 
more or less constipated for several years, with 
the onset of acute abdominal pain while straining 
or when at stool, it will give us a lead that will 
help make a correct diagnosis. 

I think Dr. Garrett’s paper is on a subject that 
we should give careful study. We see more of 
these cases since we have begun the roentgen-ray 
study of the gastro-intestinal tract, with opaque 
solution. Ruptured diverticulum is more common 
than was formerly taught. Diagnosis is very 
difficult. The mortality is extremely high. 

Dr. S. C. Barrow (Shreveport): The position 

of the radiologist in the. question under discussion 
is just exactly the opposite of that in which he 
is placed in the previous paper on osteomyelitis. 
This is evidenced by the fact that the enormous 
increase in the number of cases being reported 
since the advent of the roentgen-ray study is 
apparent. 

Diverticulitis, diverticulosis and diverticula are 
terms that are applicable to those extraneous 
pockets to the digestive tract. They occur all the 
way from the mouth, you may say, or the upper 
esophagus, to the rectum. The diverticula in the 
upper part of the tract are usually congenital, 
while those in the colon are not so often so, as 
those above. 

I could not attempt to discuss the' paper, 
Mr. Chairman, excepting from the standpoint of 
roentgen-ray observation. 

I have a slide or two illustrating Dr. Garrett’s 
paper, including some of his cases. 

Dr. Hendrix made a remark to you which I 
want to take the opportunity of stressing. Please 
do not tell your radiologist, please, to give a 
patient an opaque enema when you suspect a 
diverticulitis. Tell the radiologist that you would 
like to have the colon examined, that you suspect 
diverticulitis. Personally, I do not believe the 
opaque enemas under the roentgen-ray, consider- 
ing their danger, are of any value. Our technic 
is to feed the patient barium, and I am backed 
in this by the most high authorities. Let it go 
down through the processes of peristaltis and 
pack into the various diverticula pockets and you 


Garrett — Diverticulis of the Colon with Special Reference to Sigmoid 


11 


will get the demonstration of the diverticula, 
whereas you will miss it if you attempt to do it 
the other way. 

/The case Dr. Hendrix spoke of I diagnosed years 
ago by the oral method of giving the barium, and 
my diagnosis was refuted in several clinics. The 
man was put on the table and irrigated with the 
simple diagnosis of colitis. His diverticula rup- 
tured and he died. 

Don’t tell your radiologist how to do it, please. 
Select one that you have some confidence in and 
put the matter as to how he shall do it up to him. 

(Slide) This is one of Dr. Garrett’s cases, as 
I remember it. You will notice the multiple diver- 
ticula. Down in this area you can see vaguely 
two of the extraneous pockets which are in the 
descending lower portion of the colon. 

(Slide) We have over here a series of diver- 
ticula. Here is the duodenal cap. Here is the 
diverticula at this point. Here is a large one here, 
and another at this point. She had three large 
ones distal to the duodenal cavity. 

(Slide) Dr. Garrett makes special reference to 
the descending colon, and you can see the extra- 
neous and extra colonic shadows which represent 
infiltrated pockets in the colon. 

(Slide) Right in this area is a diverticula, a 
large pocket, from the transverse colon. 

f Slide ) Here you see the multiplicity of pockets 
along the descending colon which Dr. Garrett’s 
paper has special reference to. 

Dr. L. J. Menville (New Orleans) : I have not 

heard anybody mention the fact this morning that 
cases of diverticula are often seen in stout indi- 
viduals, as represented by the hypersthenic build 
or habits of the individual. A patient complain- 
ing of nain referred to the lower left quadrant of 
the abdomen, should be examined carefully for a 
palpable mass at the site of the pain, so often 
encountered in diverticulitis. Of course, that does 
not occur in all cases, but it might be well to bear 
in mind that patients having definite pains in the 
lower left quadrant of the abdomen, especially 
stout individuals, often prove to be a case of diver- 
ticulitis with a corresponding palpable mass. 

That brings to mind the fact that the use 
of the barium enema should be emphasized, and 
it should be used more often than it is now being 
used. In some of the larger clinics, not only of 
this country but in Europe, all patients manifest- 
ing pain in the abdomen are referred for a barium 
enema. 

Roentgen-ray examination offers the best method 
of diagnosis in diverticulitis. No doubt, however, 


some few cases are being missed by the radiologist 
unless certain care is manifested. For instance, 
we may have several diverticula in the lower 
sigmoid that will not be visualized if the barium 
enema is administered with great pressure and 
with a long rectal tube. In such instances the 
enema should be made to flow in the bowel grad- 
ually and having it under absolute personal 
control where it may be momentarily stopped for 
observation. 

I think it is impossible for any roentgen radiol- 
ogist to make a diagnosis of diverticulitis from 
the roentgen-ray examination alone, because we 
are incapable of demonstrating inflammatory 
products, per se, but we offer with the roentgen- 
ray the best method of visualizing diverticula. 

Dr. C. P. Rutledge (Shreveport) : I have some 

slides that demonstrate some of these cases very 
graphically, and I use both the barium enema and 
the barium meal. Barium meal will show more 
diverticula than the barium enema. There is no 
question about it. But the barium enema is of 
value especially in view of these acute conditions. 
In some of these conditions where you know you 
have an acute inflammatory condition with partial 
obstruction it is probably unwise to give barium 
meal, but you might be perfectly justified in using 
the barium enema. 

The first case I will show is one on which I was 
called early one Sunday morning when I was presi- 
dent of our local society. “For God’s sake, come 
down quick, I have a left side appendix.” I went 
down. We gave a barium enema very carefully, 
and then we took him over to the roentgen-ray 
department and gave him the barium meal. 

(Slide) You will notice here marked spasticity 
in the sigmoid. He wanted to find whether his 
appendix was on the left or right side. The fluoro- 
scope and the plate shows us much better than 
the slide the appendix in the normal position, 
with no inflammation around it. He had very 
great spasticity in the sigmoid, probably diver- 
ticulitis, and we suggested that the patient be put 
to bed and a reexamination made at a later date. 

(Slide) Five days later we made another exam- 
ination after the man had been in bed on a 
starvation diet, or very bland liquid diet, and you 
see here a little pocket at this point. I might say 
that just previous to this examination the man 
evacuated about two ounces of pus by the rectum, 
probably a ruptured diverticulum, and with the 
barium enema we were able to find it five days 
after the man came in for observation. 

(Slide) Here is a case that my friend Dr. Bar- 
row won’t believe is so, diverticulum of the 


12 


Garrett — Diverticulis of the Colon with Special Reference to Sigmoid 


appendix. It has not been proven. I don’t blame 
him for not believing 1 it, but if he had seen it as 
I saw it I don’t think he would argue the point 
at all. I can get the appendix between the 
fingers. You can see two or three diverticula very 
distinctly. This is a case of chronic diverticulosis. 

I examined two local postmasters and did com- 
plete G-I examinations, and both had diverticulosis. 
I don’t know whether it is a postmaster’s disease 
or not. You see diverticula here. This is the 
appendix here and shows very nicely on the fluoro- 
scope and on the original film. 

(Slide) That appendix was down in the hernial 
sac. This is the case of another postmaster, using 
barium meal, and this was made seventy-two hours 
after the meal. There are any number of diver- 
ticula. Every one of these round specks repre- 
sents a diverticulum. This is the appendix here. 
These are not diverticula of the appendix here. 
They are scattered from the cecum right through 
into the rectum. I counted a little over 300 in 
that man’s colon. I never have seen a case on 
record which would anywhere near compare with 
it. The peculiar thing about it is that this man 
had no symptoms whatever. Several years pre- 
vious to the examination he did give a history of 
voluminous hemorrhage. He was kept in bed 
until the hemorrhage ceased and he made an un- 
eventful recovery. Previous to this examination, 
he had a similar attack, a hemorrhage from the 
rectum. He was put to bed and kept on liquids 
or all starvation diet for several days, and I ran 
this series of films. Even at the twenty-four hour 
film you can see any number of diverticula. 

(Slide) This is ninety-six hours after. You see 
nothing left but the diverticula. If we had gone 
ahead, we would probably have been able to show 
very few of the diverticula. You see any number 
in ninety-six hours after the barium meal. Here 
it is all around the rectum, and anywhere you 
look, you find them. That man is now apparently 
well. He had no other attack. He was put on 
some type of mineral oil which kept his bowels 
active. 

(Slide) In this case you see any number of 
diverticula scattered. This is the same man seven 
days after the first plate with the barium enema. 
You see, they don’t show nearly as well as with 
the barium meal. 

(Slide) This is a case of right-sided diverticu- 
litis. The surgeon said it looked very much like 
an acute appendix but he was afraid it wasn’t. 
He said he had a hernia. It probably wasn’t that. 

I made a complete G-I series on him and diver- 
ticula were shown on the meal film. These were 
made about three or four days ago. You notice 
here, it shows very plainly. Here is the sigmoid 


over at the right; not on the left at all. The man 
looks as though he has two tranverse colons. He 
had nothing going up here in the left lower quad- 
rant where you expect to find the pelvic colon and 
sigmoid. Everything was pulled over to the right. 
The head of the cecum was fixed adherent to the 
sigmoid. You have the area of spasticity, the de- 
scending colon coming down here. You have the 
area of spasticity from here down to the rectum. 
Only by an ingested meal film could we show 
numerous diverticula. With the barium enema you 
can see the spasticity over the complained of area. 

With the barium meal, just a little appendix 
showed. I am quite sure he had an inflamed 
appendix, but it was mixed up with the diverticu- 
litis and was part of it. That man has* been 
advised to have a resection from here down to the 
rectum. 

Dr. A. J. Thomas (Shreveport) : Two points 

have been brought out by the discussionists con- 
cerning the radiological technic and the radiologic- 
diagnosis of this condition in which, as you will 
note, two competent radiologists give you different 
instructions. Dr. Barrow states do not use a 
barium enema. 

Dr. Barrow: Excuse me, I said you could use 

them but I said be careful. 

Dr. Thomas: Dr. Menville says to use them 

and gives the results of six months’ operations 
in the Mayo Clinic under the late Dr. Carmen 
who was one of the great radiologists of the world 
and a specialist in gastro-enterologic conditions. 

My idea of thisi thing is simply this: If your 

patients are ambulatory, in other words, they can 
come to your office, and you refer them to the 
radiologist, I think he should give the barium by 
mouth and later on check up by the enema. If 
your patient is bed-fast with probably a rigid 
abdomen, an acute surgical abdomen in other 
words, or something approaching that type, it is 
useless to argue. I don’t think there is any argu- 
ment present as to what the possibilities of 
mechanical irritation would be with the enema. In 
other words, in that type of case, I think the 
contrast meal should be administered by the 
mouth. 

One other point that Dr. Rutledge states was 
with regard to diverticulum of the appendix. I 
looked up the literature and it is rather rare. 

I thought I had such a case as that. It was an 
ambulatory case in which there were four circum- 
scribed areas of increased density within the lumen 
of the appendix which was dilated and very much 
elongated. After the appendix had evacuated, 
these four circumscribed areas were still present; 


Nobles — Chronic Appendicitis 


13 


in fact, they were present four days. I think it 
was the fifth day after ingestion of the contrast 
meal by mouth. 

The conclusions I gave to the surgeon was 
chronic appendix and multiple diverticulum, or 
diverticula of the appendix. At operation I saw 
the appendix. It was some eight inches long, a 
chronic appendix, and it had four fecaliths 
within it. 

I don’t see how anyone radiologically could 
differentiate that type of pathology or lesion 
from the diverticula. It is practically impossible. 
It is an operative case and no harm is done in 
your diagnosis. I just wish to stress that it looks 
like there is nothing in the practice of medicine 
that is 100 per cent correct. 

Dr. W. P. Lambeth (Shreveport) : I want to 

say just a few words about the diverticula oper- 
ation that have not been mentioned, and that is the 
question of anesthesia. You know these patients 
are all sick. As a rule, they have been sick for 
some several days. 

There are two types of anesthesia appropriate 
to that type of surgery, I think, sodium amytal, 
and gas oxygen. By using sodium amytal in this 
type of patient we get what the surgeon wants. 
He wants a quiet patient, and he wants a quiet 
abdomen. By using sodium amytal as a pre- 
medication, we can give the patient nitrous or 
ethylene, ethylene with twenty-five per cent oxygen 
or nitrous with twenty. We have our carbon 
dioxide for any emergency that might come up. 

Certainly, in one particular hospital, the Meth- 
odist Hospital in Indianapolis, there wouldn’t be 
any question as to what type of anesthesia to use. 
It would be sodium amytal and gas. Over in 
Lafayette, Indiana, there would be no question 
about spinal. They give spinal. Either one of 
these anesthetics is the thing to use in that type 
of surgery. 

I remember a case I happened to see in Lafay- 
ette, Indiana, a child twenty months old. They 
thought the child had a ruptured appendix. It had 
been sick for about a week, and they thought it 
was an abscessed appendix. They could feel the 
mass in the side. The question came up about the 
anesthesia. It was discussed in a good clinic 
among the surgeons. I happened to be right from 
Indianapolis where they had been using sodium 
amytal, and they asked me to give sodium amytal 
and gas to this patient. After the patient came 
to the table, they found the pulse up to about 
150 and practically no blood pressure. The anes- 
thetist at this place happened to be particularly 
interested, and so was the surgeon, in spinal, and 


it was decided to give this child spinal. We gave 
fifty milligrams of novocain in spinal fluid with 
twenty milligrams of ephedrin. We opened the 
abdomen and didn’t find the abscessed appendix, 
but we found a fecalith abscess and diverticula, 
which necessitated resection of about ten inches 
of gut. The operation was only thirty minutes. 
The fellow took out the section of the intestine 
and the appendix, because the child was actually 
doing better under the anesthesia than when he 
went on the table. 

I think in this type of case I would recommend 
either sodium amytal and gas or spinal. 

Dr. B. C. Garrett (closing) : I wish to express 

my appreciation of the liberal discussion that 
paper has had. 

There is only one point I might call attention 
to, the fact that when you get in there to resect 
the diverticulum, don’t look for a big pouch all the 
way because you won’t see it. The opening is usu- 
ally very small, but about the size of a knitting 
needle or the lead of a pencil. 

CHRONIC APPENDICITIS.* 

E. R. NOBLES, M. D., 

Rosedale, Miss. 

In presenting this subject for your con- 
sideration and discussion I will only 
attempt to touch upon the more prominent 
features of this disease. My effort will be 
to correlate the few basic facts that might 
be helpful in the problem of its diagnosis 
and management. 

Recently certain observations have been 
noted and brought to our attention which 
seem to indicate that from forty to fifty 
per cent of the operations for chronic 
appendicitis find the patients unrelieved of 
their symptoms. These figures are calcu- 
lated to disturb the hitherto complacent 
attitude in the matter, and represent a 
challenge to us that they be improved. 

The causes of the poor showing are 
admittedly diagnostic, and insufficient ex- 
ploration at the operating table ; and I will 
therefore give these two propositions chief 
consideration in the body of the paper. 

*Presented by invitation at Belzoni meeting of 
Delta Medical Society, October 8, 1930. 


14 


Nobles — Chronic Appendicitis 


No one has yet risen to deny the fact 
that the acute appendix is the most crim- 
inally inclined of all the organs in the 
abdomen, and if permitted to remain after 
an attack it becomes a liability to the 
possessor, either directly or indirectly, in 
future gastro-intestinal troubles. Indeed, 
there is strong doubt in the minds of many 
that if after becoming acutely infected it 
ever entirely recovers. 

We know that this organ has anatomy, 
histology and physiology similar to the re- 
mainder of the gastro-intestinal tract in 
every detail, with exceptions only in that 
it has an abundance of lymphoid tissue 
implanted ~ctween the mucosa and sub- 
mucosa in early life, a blood supply out of 
propoition to its size, and a narrow lumen. 

That it has a minor part in the final 
digestive processes is accepted, and through 
its nerve supply it is intimately connected 
with the other organs of digestion. This is 
why a disturbance in it may be registered 
in any of them, but particularly because of 
this innervation, epigastric discomfort is 
the most common referred symptom. 

In the realm of pathology so far as its 
ehronieity is concerned there is much still 
m dispute, for there seems to be no com- 
mon opinion, and much uncertainty exists 
among able pathologists and clinicians as 
to what this term chronic appendicitis is 
meant to imply. 

There are those in high places whose 
^opinions are worthy of respect, who main- 
tain there is no pathologic basis for this 
disease and that it is wholly a myth. There 
are others of equal rank who insist that it 
is a left over from a previous acute in- 
flammation; an end-result rather than an 
active process. 

Others insist that the pathology repre- 
sents a manifestation of general abdominal 
disease of which the appendix is only apart 
and offer this as a reason why in certain 
cases removal of the appendix or gall blad- 
der, or both, does not relieve the symptoms. 


However, these opinions may be, there 
is abundant evidence from other equally 
notable investigators that the organ can 
and does, become affected chronically and 
that the condition is often seen as a con- 
tinuing pathological process confirmed ex- 
clusively to the appendix. 

One suggestive evidence of this is the 
rapid pathologic change, in some cases 
over night, from the initial pain, in an 
acute attack, to gangrene, perforation and 
adhesions, with no history of a previous 
involvement. I can reconcile this observa- 
tion only with the idea that it was an 
acute attack superimposed upon an already 
chronically diseased appendix. There are 
those who believe that in all cases it is the 
chronic change which provides the soil for 
the acute infection. 

This is of interest chiefly from an 
academic viewpoint, but for those who 
admit its physiology and proneness to 
acute infection, and then deny to it the 
pathology incident to chronic change, are 
making of this organ a unique one within 
the system. 

We know that it exhibits chronic change 
m the presence of the tubercule bacilli, that 
it becomes affected with carcinoma and 
actinomycosis, that it has lymphoid tissue 
similar in many respects to the tonsil, 
and organ and tissue frequently affected 
chronically. 

It is therefore conceivable that a slowly 
acting bacterial irritant could find favor- 
able ground here for growth and develop- 
ment, and if drainage becomes interfered 
with through a partial blocking of the 
lumen by concretions, feceliths or foreign 
bodies, and through kinks or twists by its 
becoming adherent to adjacent organs from 
an extraneous infection. 

It would then require no wide stretch of 
the imagination to assume that a balance 
could be struck here as elsewhere in the 
body between invader and defender, serving 
as a focal point from which infection may 


Nobles — Chronic Appendicitis 


15 


spread, or to produce mild toxic symptoms 
resulting ultimately in a fibrous degenera- 
tion with the possibility of the appendix 
becoming adherent to some distant organ. 

We also know that there is a likeli- 
hood of the discrepancy between the path- 
ological findings and the clinical symptoms 
persisting inasmuch as the appendix can 
remain symptomless and exhibit any or all 
of the pathological changes claimed for it; 
or continue to produce symptoms with 
none of them demonstrable. 

There is another source of confusion in 
trying to fix a certain group of symptoms 
upon one organ and naming the disease 
chronic appendicitis, when as a matter of 
fact many times other etiologic factors are 
involved in the production of these, and 
occasionally the disturbance that originated 
in the appendix is no longer dependent upon 
it by the time the patient presents himself 
for examination. 

A pathologic picture and a clinical pic- 
ture would not therefore indicate the same 
thing. As clinicians we are interested in 
this because of its bearing upon the mul- 
titude of symptoms frequently presented 
even by one patient for differentiation and 
serves as a warning to the numerous pit- 
falls in making the diagnosis. 

That the symptoms of this disease may 
be local, referred or general is a natural 
assumption when the application of the 
knowledge of its pathology has been made, 
but if there should be a demand for an 
orderly array of symptoms upon which to 
base the diagnosis it would be impossible 
to supply them, except to state that they 
are characterized by their irregularity as 
compared with signs of other abdominal 
disease. 

It might be said that for the most part 
these patients suffer from stomach trouble, 
pain, local tenderness as a rule, gas distress 
and indigestion; and that these symptoms 
may be due to three types of derangement, 
namely, mechanical interference with the 


intestines as a result of stasis, reflex dis- 
turbance manifested chiefly by pyloric 
spasm, and toxic absorption from the ap- 
pendix exhibited by the systemic signs that 
are often prevalent. 

The objective signs are concerned chiefly 
with the abdominal reflexes, many of which 
are extremely unreliable. Morris suggests 
that resonance in many cases is more 
pronounced on the right side as compared 
with the left side, and insists that this is 
due to a continued distention of the cecum 
and ascending colon caused by innervation 
fatigue reflected from the chronically 
irritated appendix. 

The history of one or more acute attacks, 
while greatly helpful, but which may re- 
quire the talent of a detective to uncover, 
is not absolutely essential to the diagnosis, 
and to try to avoid it unless such a history 
is obtainable is untenable as Larimore has 
recently stated for four reasons : 

1. That an acute attack is certain of 
diagnosis. 

2. That later it may be definitely diag- 
nosed from its history. 

3. That a history of an acute attack can 
of certainty be brought out. 

4. That chronic appendicitis is without 
exception a residual disease. 

But in the absence of a history of an 
acute attack either recent or remote, the 
diagnosis is made purely on circumstantial 
evidence, which our legal friends tell us is 
the best evidence obtainable if it can only 
be made strong enough, but in fixing guilt 
upon the appendix, I think the safest ground 
always is to assume its innocence until after 
all the possible complicating elements are 
thought of and ruled out in an honest and 
intelligent manner, giving especial con- 
sideration to those conditions that an 
abdominal section wi'I not relieve, and 
in which such a procedure might prove 
harmful. 


16 


Nobles — Chronic Appendicitis 


There are many of these that are rela- 
tively unimportant but should be thought 
of, and of the more important ones doubt- 
less first place is taken by the neuralgias, 
intercostal and costo-lumbar, given promin- 
ence by the recent work of Carnett and 
Boles; and their method of differentiating 
intra-abdominal and parietal tenderness is 
of value and should be used if there is any 
suspician of neuralgia in the lower inter- 
costal nerves. 

Pyelitis, right sided, and kinks or twists 
in. the ureter on the right side should be 
given consideration, it often requiring cys- 
toscopy, ureteral catherterization, and pye- 
lography intelligently to rule these out. 

Arthritis of the spine, sacro-iliac strain, 
intestinal worms in children, afebrile and 
atypical malaria of the aestivo-autumnal 
type, tuberculous glands in the right iliac 
fossae all should be eliminated by measures 
appropriate to each. 

The visceroptotic with a pain in the right 
side due to the drag on the appendix and 
cecum, should generally be treated med- 
ically, watching especially for the type who 
presents a general constitutional asthenia, 
associated with a mucous colitis and ileal 
stasis. 

The surgical lesions most often confused 
with, or mistaken for chronic appendicitis, 
are chronic peptic ulcer and chronic chole- 
cystitis and undoubtedly in many of these 
cases the distinction is impossible. Cer- 
tainly in some cases a dual or even a triple 
diagnosis, while not so classical, comes 
nearer meeting the diagnostic problem. 

The lymphatic drainage from the ap- 
pendix and the possibility of transfer of 
infection through the portal system to the 
liver encourages the belief that a chonic- 
ally damaged appendix is often primary to 
ulcer and gall bladder infection. 

I believe in these cases the greatest single 
help comes from a complete and discerning 
history, emphasizing especially the in- 


fluence of food upon the pain and epigas- 
tric distress generally present and the kind 
of food causing the most discomfort. 

The next step is a well conducted physical 
examination of the abdomen, in which, of 
course, the personal equation plays a large 
part. A radiologic survey of the entire 
gastro-intestina.1 tract which should include 
cholecystography is certainly indispensable 
in many cases, though in offering indirect 
rather than direct evidence of disease in 
the appendix. Contrary to the opinion of 
some patients the radiologist should not be 
expected to make the diagnosis and direct 
the treatment. 

The diseases next to be distinguished be- 
cause of their frequency are those of the 
right uterine appendages which usually can 
be ruled out by the history of accentuation 
at the menstrual time, or by a vaginal dis- 
charge, together with a pelvic examination. 
A retroverted uterus will not infrequently 
cause pain in the right side due to the strain 
on the attachments of the cecum and ap- 
pendix, either because the prolapsed cecum 
is hanging on them or the ovario-pelvic 
ligament is pilling on them. 

A mobile tender cecum with, or without, 
coloptosis, if associated with ileal stasis 
can usually be determined by the radiologic 
examination. 

Incipient hernia should be thought of 
when confronted with pain in the right 
side, and other conditions are a mild 
chronic pancreatitis, carcinoma or tubercu- 
losis of the cecum, tuberculosis of the 
peritoneum, chronic diverticulitis and early 
psoas abscess, as well as certain abdominal 
adhesions. 

Of these but few can be diagnostic with 
any degree of certainty except by inspect- 
ing and touch, so when the diagnostic prob- 
lem is reduced to these we might well ob- 
serve the dictum “when in doubt operate.” 

Chronic appendicitis in children has not 
been given the attention that it justly de- 


Nobles — Chronic Appendicitis 


17 


serves, and the lesion should always be 
suspected when there is a history of list- 
lessness, a capricious appetite, colicky pains 
at irregular intervals, with at times nausea 
and vomiting. 

If in addition there is a statement that 
the child cannot bear anything firm around 
his abdomen such as a belt, or seems to 
avoid rought games because of probable in- 
jury to the abdomen and the examination 
reveals tenderness over McBurney’s point, 
we may be reasonably assured that it is a 
case of chronic appendicitis. 

The diagnosis of this disease, as I have 
attempted to show, should in most cases 
represent the sum total of a careful clinical, 
physical, radiological, and laboratory ex- 
amination, judged conservatively with 
proper appraisal of each, for none of the 
symptoms and findings have unequivocal 
value. 

Undoubtedly in a large number of cases 
of chronic appendicitis seen early or before 
this low grade infection has caused damage 
in other organs, when the appendix is acting 
simply as a local irritant, or perhaps a point 
a focal infection, or from which is coming 
mild toxic symptoms, simple removal is fol- 
lowed with spendid results. 

In another type when there is a definite 
pathology in the appendix but in addition 
adhesions about the cecum, perhaps Jack- 
sons membrane or probably Lane’s kink 
with or without a ptosis of the cdcum and 
colon, simple removal and the severance of 
adhensions and a fixation or plication pro- 
cedure best suited to the conditions found 
in the ptotic cecum or colon is followed 
with good results in all cases except those 
followed by formation of new adhesions 
unfavorably located for good bowel func- 
tion. 

A third type is that in which there is no 
evident pathologic change in the appendix 
beyond an obliterating appendix, but the 
damage has passed on to the gall bladder, 
stomach, or other abdominal organs. 


Simple removal in these cases, unless ac- 
companied by proper surgery to the other 
damaged organs, will in a very short time 
be followed by a recurrence of the symp- 
toms. 

A fourth type is that in the nervous 
patient, or in the visceroptotic, or the one 
who is passing or has passed into a state 
of chronic invalidism, when the kinked, 
twisted, adherent or oblitering appendix is 
only one episode in the general disable- 
ment, and it is in these patients in whom 
surgery alone does not meet the full therau- 
peutic program, for they need additional 
care; dietary, hygienic, orthopedic maybe, 
and often mental and social. 

Certainly it requires keen judgment in 
many of these to determine whether surgi- 
cal or mental treatment should be the first 
instituted. 

CONCLUSION. 

In conclusion I will say that this paper 
on so important a subject is necessarily 
sketchy. It is intended as a sort of com- 
mentary on the salient features of this 
disease. 

One hope was to stress such features as 
would emphasize the dangers lurking in the 
fetish of pain in the right side as direct 
evidence of chronic appendicitis. That it is 
imperative to go about the diagnosis, not 
by a poke in the side followed by a conclu- 
sion, if there is a history of indigestion ; but 
in a methodical manner before and not after 
the appendix is removed, if our results are 
to be improved. 

To beware especially of the neurotic with 
many pains distinguished by the multiplic- 
ity of their sites and the variety of their 
types, in whom if a diligent search be made 
will be found other evidences of the stig- 
mata of decline. 

Also the type common enough who seem 
to be alright except for the intimacy exist- 
ing between the cerebral cortex and the 
right iliac fo:sa. 


18 


Mattingly — Acute Perforation of Peptic Ulcers 


That it is essential to distinguish the 
surgical from the non-surgical lesions that 
might be mistaken for chronic appendicitis, 
and that once an operation is decided upon 
unless a long enough incision be made to 
inspect with the lease amount of trauma- 
tism all the abdominal viscera, the patient 
has had inadequate surgery. 

Note: To those interested in the subject of 
chronic appendicitis, I would recommend articles, 
pertinent to the subject, written by the following: 
men: John B. Deaver, H. C. Eoyster, C. A. Murphy, 
J. B. Carnett and R. Boles, J. A. Larrimore, H. A. 
Koster, Arthur Hertzler, and R.T.Morris. These 
papers have appeared at various times in the Amer- 
ican Journal of Medical Sciences, Southern Sur- 
gery, Canadian Medicine, Southern Medical Jour- 
nal, New York Medical Journal, and the Journal of 
the American Medical Assoociation. 

ACUTE PERFORATION OF PEPTIC 
ULCERS.* 

C. WALTER MATTINGLY, M. D.,f 
New Orleans. 

Ninety-one cases of acute perforation 
of gastric and duodenal ulcers were ad- 
mitted to Charity Hospital (New Orleans) 
from January 1, 1926, to October 2, 1930. 
Seventy of these ulcers were located in the 
duodenum; the remaining twenty-one were 
gastric. Of the ninety-one patients, fifty- 
nine were white and thirty-two colored. 
Only two of the cases reported here occurred 
in the female. 

The cause of acute perforation is un- 
known. In the more recent literature, the 
etiology of perforation of peptic ulcers 
does not occupy much space. O’Flyn cites 
a case which he says supports the theory of 
congenital predisposition to duodenal ulcer. 
The perforation was sudden in a boy four- 
teen years of age. 

According to recent studies by Meyer 
and Bram, over-distension of the stomach 
by food or manual exertion had compara- 
tively little to do with the actual rupture 

*Read before the Orleans Parish Medical Socie- 
ty, October 27, 1930. 

fJunior House Surgeon, Charity Hospital, New 
Orleans, La. 


in their series of sixty-two cases. On the 
contrary, eight of the ninety-one cases here 
reported perforated soon after eating a 
heavy meal or after drinking excessively. 

SYMPTOMS AND DIAGNOSIS. 

In seventy-five cases, this abdominal 
catastrophe occurred with an onset that 
was of startling suddeness. The picture is 
readily brought to mind by relating the 
story of a man who, while out in his lot to 
catch a mule, experienced a most excruci- 
ating general abdominal pain that caused 
him to drop to the ground in his own track. 
The man gave a further history of being 
so doubled up with pain that he had to be 
carried to his home. I have observed that 
a number of these patients complain of 
upper abdominal pain radiating to the pos- 
terior aspect of the neck. (A similar find- 
ing is present in ruptured ectopic preg- 
nancy) . Pain in the neck or in one or both 
shoulders was present in thirteen of the 
cases reported here. 

It is surprising to note how infrequent 
vomiting is present in acute perforations 
of these ulcers when nothing is given 
orally. Thirty-three of the patients vomited 
previous to operation, but most of these 
gave- a history of having taken purgatives 
or other medication previous to hospital 
admittance. 

In sixty cases, there was a past history 
of dyspepsia varying in duration from five 
days to fifteen years. The average duration 
was three years and seven days. The re- 
maining thirty-one patients gave no com- 
plaint previous to perforation. Of the 
seventy duodenal ulcers, 33 patients gave 
a history in keeping with such an ulcer; 
two others gave a gastric ulcer history. 
Of the twenty-one cases of gastric ulcers, 
six gave symptoms referrable to such 
ulcers; eleven did not; and two gave 
duodenal ulcer histories. 

Early in the picture, the patient 
generally presents an “agonized” look, a 
normal pulse, and a normal or subnormal 
temperature. Temperatures of forty cases 


Mattingly — Acute Perforation of Peptic Ulcers 


19 


taken previous to operation averaged 
98.6° F. — the extremes being 101° and 
95.8° F. Sixty cases had a pulse rate that 
averaged ninety with the highest 132 and 
the lowest 59. 

Examination revealed a true board-like 
rigidity of the abdomen in fifty-one cases. 
This rigidity is particularly noted early 
after perforation ; later the general picture 
is obscured by complicating peritonitis 
and meteorism. The presence of a pneumo- 
peritoneum was shown by diminished liver 
dullness in twelve cases. Roentgen-ray 
examination showed the presence of sub- 
diaphragmatic air in eight of the thirteen 
cases so examined. This roentgen-ray 
examination is of great importance in the 
diagnoses of early and late cases. 

Another very important procedure is the 
rectal examination. This showed in the 


majority of the cases a marked peritoneal 
tenderness in the region of the recto- 
vesicle pouch. 

The white cell blood counts of twenty- 
three patients taken previous to operation 
showed an average total of 15,495. The 
highest total white was 31,250 and the 
lowest 8,500. The poly morphonuclear leu- 
kocytes averaged 85.6 per cent with a high 
count of 91 per cent and a low count of 
75 per cent. 

The blood Wassermann was strongly 
positive in six and negative in sixty-eight 
cases. 

TREATMENT. 

Immediate surgical intervention is 
recommended. 

I am in full accord with Podlaha who 
pleads for the simplest operation, because 



Erect postero-anterior view of the lower chest and upper abdomen showing the presence of air beneath the diaphragm. 



20 


Mattingly — Acute Perforation of Peptic Ulcers 


the indication is vital, not radical — sutur- 
ing the opening, covering with a flap of 
omentum, and cleaning out the peritoneum. 

Pannett, in his recent edition of surgery 
of gastro-duodenal ulceration, states that 
simple suturing has been done more 
frequently than any other operation. The 
other method of treatment described by 
Pannett is that of suturing together with 
gastro-jej unostomy. Deaver and Pfeiffer 
are quoted as being in favor of using this 
method in early cases with little shock. 

All of the ninety-one cases of this series 
were treated surgically. Eighty-seven of 
these cases perforated on an average of 
twelve hours and twelve minutes prior to 
surgical intervention, the extremes being 
two and. seventy-eight hours. The time 
interval between perforation and treatment 
was unknown in the four remaining cases. 

The surgical approach on seventy-seven 
of these was through a high right rectus 
muscle splitting incision, and in nine 
through a right paramedian incision. In 
eighty-seven cases the ulcers were first 
cauterized and then sutured with paraffin- 
ized silk in all cases except one in which 
linen was used. In suturing the ulcer, 
purse strings or interrupted sutures were 
used. The raw surface was covered by 
means of Limbert sutures or an omental 
flap, when the latter was available. In 
some instances, both were used. Two cases 
were treated by simple closure with pylor- 
oplasty; another by closure and append- 
ectomy; and the remaining one by closure 
and enterostomy. We have yet to find 
where simple closure of the ulcer in this 
manner caused marked encroachment upon 
the lumen. All roentgenograms, that is 
gastro-intestinal series, taken post-opera- 
tively failed to show any gastric retention 
at the end of six hours. 

Following the above closures, the peri- 
toneal cavity was cleaned as far as possible 
with the suction apparatus. All but six 
cases were drained. The drains of the first 
cases of the series were placed in the 


region of the perforation; but, now when 
drains are used, they are generally placed 
so that one is in the right subphrenic fossa 
and another in the subhepatic fossa 
(Morrison’s pouch). In the last two cases 
of this series, the peritoneal cavity was 
cleaned out as much as possible with the 
suction apparatus and five hundred to one 
thousand cubic centimeters of warm, 
sterile, normal saline placed in the ab- 
dominal cavity. This fluid content was then 
aspirated and the abdomen closed without 
drainage except for a smaller rubber tissue 
used to drain the subcutaneous area. I now 
use rubber tissue to drain the subcuta- 
neous area due to the fact that thirty-four 
cases in this series had infected wounds 
post-operatively. 

Abdominal fluids taken for bacteriologi- 
cal study were negative for organisms in 
thirty-seven of the forty-six cultures made. 
Of the nine that were positive, four cul- 
tures were positive for staphylococcus and 
streptococcus ; two for colon bacillus ; one 
for streptococcus; one for staphylococcus, 
streptococcus and colon bacillus; and one 
for colon bacillus and pneumococcus. 

The anesthetics used were : ether in 
sixty-seven cases; local, six; spinal, six- 
teen; local and ether, one; and spinal and 
ether, one. Of late, spinal (novocain) has 
been used in the majority of cases with 
good results. 

Orders for the average case for the first 
twenty-four hours post-operatively were: 

Nothing by mouth for forty-eight to 
seventy-two hours for the first cases of this 
series. Of late, tap water has been allowed 
in small amounts, from twenty-four to 
twelve hours up to immediately after 
the patient reacts. The average elapsed 
time before fluids were given by mouth for 
the entire group was thirty-one hours and 
fifty-four minutes with a maximum wait 
of ninety-five hours and a minimum of 
zero, that is fluids immediately. 

Give by hypodermoclysis 500 c.c. normal 
saline and 500 c.c. 10 per cent glucose 


Mattingly — Acute Perforation of Peptic Ulcers 


21 


every eight hours and thereafter twice 
daily for two or three days. In eight cases, 
one to eight infusions were resorted to 
during the post-operative treatment. 

Loosen drains (if any) daily and remove 
after seventy-two hours. Remove subcuta- 
neous drains in thirty-six hours. 

Elevate head of bed twelve inches. 

Give morphine sulphate in adequate 
dosage for rest. 

Pass Jutte tube and allow same to drain. 


LATER TREATMENT. 

After the first day, water, strained 
soups, fruit juices or cold drinks were 
given in small amounts up to about the 
third day. A modified Sippy diet was 
started on the third to the seventh day; 
and Sippy diet powders began on the 
seventh to the thirteenth day. 

Nine transfusions were given in this 
series. 

A heat tent was used over the abdomen 
in a few of the cases. 



2. Erect lateral view of the lower chest and upper abdomen showing the presence of air beneath the diaphragm. 


22 


Mattingly — Acute Perforation of Peptic Ulcers 


The complications that developed in this 
group of ninety-one, other than those men- 
tioned under the causes of death were : 
uremia, 1 ; diarrhea, 3 ; eviseration, 2 ; 
pneumonia, 4 ; second acute perforation, 1 ; 
general peritonitis, 1 ; and gastric hemor- 
rhage, 1. 

The average stay in the hospital, exclu- 
sive of those dying in the hospital, was 
24.5 days — the longest 84 and the shortest 
11 days. 

Four of the patients returned later and 
gastrojujenostomies were performed. 

In the series there were thirteen deaths, 
a 14.2 per cent mortality. 

The causes of death and the duration of 
life following primary operations are as 
follows : 

1. Perforated gastric ulcer, subdi- 
aphragmatic abscess, pleurisy with effusion, 
tertiary syphilis ; forty days. 

2. Acute perforation of gastric ulcer 
and general peritonitis; four days. 

3. Acute perforation of gastric ulcer; 
three days. 

4. Acute perforation of gastric ulcer in 
a morphine addict (twelve grains daily) ; 
sixteen hours. 

5. Anesthetic (ether) ; three hours. 

6. Ruptured duodenal ulcer and general 
peritonitis; thirty-five hours. 

7. Perforated gastric ulcer, subphrenic 
hematoma, right empyema and toxemia ; 
eighty-three days. 

8. Perforated gastric ulcer, pneumonia, 
and chronic myocarditis; seven days. 

9. Acute perforating duodenal ulcer, 
probable peritonitis and syphilis; forty-six 
days. 

10. Ruptured duodenal ulcer, general 
peritonitis and acute nephritis ; seventy- 
eight hours. 


11. Acute perforation of duodenal ulcer, 
and general peritonitis ; thirty-six hours. 

12. Ruptured gastric ulcer, subdia- 
phragmatic abscess, local peritonitis, acute 
iTcerative gastritis, acute myocarditis, 
acute nephritis and cirrhosis of the liver; 
fifteen days. 

13. Acute perforation duodenal ulcer, 
peritonitis; three days. 

The average elapsed time between per- 
foration and the time of operation in 
twelve of the above deaths was 22.8 hours. 
In the remaining case the time could not 
be determined. 

BIBLIOGRAPHY. 

O’Flyn, J. L. : Perforation of chronic duodenal ulcer in 

a boy. Brit. Med. Jour. 1:42, 1925. 

Podlaha, J. : Perforated gastric and duodenal ulcers. 

Casopis lek. cesk. 64 :11, 1925. 

Meyer, K. A. and Bram, W. S. : Acute perforation of 

gastric and duodenal ulcers, sixty-two cases. Amer. Jour. 
Med. Sci. 171:510, 1926. 

Pannett, C A. : Treatment of perforated gastric ulcer. 

Lancet 1:1271, 1926. 

Pannett, C. A. : Surgery of -gastro-duodenal ulceration. 

Oxford Univ. Press, 1926. 

DISCUSSION. 

Dr. Urban Maes (New Orleans, La.) : Dr. Mat- 

tingly has presented such an unusual series of 
cases, 91 instances of perforated peptic ulcer, 
that there is little to add to the discussion. It 
may not be amiss, however, to emphasize one or 
two points. In the first place, it is generally 
agreed that this is a condition which is almost 
uniformly and inevitably fatal unless it is recog- 
nized and recognized promptly; the mortality is 
exactly proportionate to the promptness or the 
delay of diagnosis. In this series the average time 
of operation after perforation was 22 hours, and 
the mortality was 13 per cent. This is really an 
extraordinarily good showing if we consider the 
type of patient concerned and the additional fact 
that many of them came from the country, and 
so were not operated on until peritonitis had been 
added to the original complication and there was 
a dual condition to be dealt with. 

From my own experience and from the sta- 
tistics of the hospitals with which I am connected 
I would say that only about 6 per cent of these 
patients fail to give a history of pre-existing gas- 
tric disturbance. The number in which the first 
manifestation of an ulcer is its perforation is 
relatively very small. Diagnosis is correspond- 


Lambeth — Hay Fever a Specialty 


23 


ingly simpler when such a story can be elicited. 
Moreover, the symptoms are characteristic, very 
sudden pain, very violent pain, and prompt, board- 
like rigidity. When such pain and such rigidity 
are present, even if corroboration is lacking, sur- 
gical intervention is both justified and demanded: 
it is better to open an abdomen unnecessarily than 
to fail to intervene in a patient with a real per- 
foration. 

It is rather generally the custom to speak of 
these patients as being in a state of shock. As a 
matter of fact, shock is a particularly bad word 
to use in this connection, because, in its strict 
surgical sense, at least, it is not present. Shock 
implies a low blood pressure and a rapid pulse, 
and these are never manifested in the early stages 
of a perforation. The pulse rate, as a matter of 
fact, is a most misleading thing in these cases; 
the fast pulse so characteristic of abdominal dis- 
asters is never present until hours later, some- 
times eight hours later, and then it indicates peri- 
tonitis and not perforation. If we wait for the 
pulse rate to change before we intervene, we shall 
lose many patients. 

The majority of cases in this series were at 
least 12 hours old, and many of them had gone 
even longer. Therefore excellent judgment was 
shown in simply closing the perforation and not 
attempting the more radical procedures which 
would have been justified if the patient had been 
seen earlier. When peritonitis is present, the 
least that can be done is the best. If such cases 
are seen within two or three hours of perforation, 
then closure of the ruptured ulcer, plus gastro- 
enterostomy for the relief of symptoms, is justi- 
fied. Mere closure of the perforation is a life- 
saving measure, but it seldom terminates the 
trouble. It is rather difficult to prove this fact 
in the type of patient handled at Charity Hospital, 
for the follow-up is inadequate if it is done at 
all, but my impression from my private work is 
that usually a recurrence can be expected at the 
end of three months. When this happens, we may 
regret our conservatism, but it is unquestionably 
wiser, even if it means a second operation later, 
for in the face of peritonitis only the most neces- 
sary surgery is warranted. 

I am not criticizing Dr. Mattingly’s procedure 
when I say that I do not care to drain the ma- 
jority of these cases, though his statement that 
the abdominal fluids were sterile in the majority 
of instances proves my point. Many perforations 
occur on an empty stomach and x he contents of 
an empty stomach are nearly always sterile; we 
are, therefore, dealing with chemical and not 
bacterial factors, and in my opinion the indication 
for drainage does not exist. When the pylorus is 
occluded by carcinoma, for instance, or when per- 


foration has occurred with a full stomach, the 
situation is different, but when the stomach is 
empty or nearly empty, we are safe in assuming 
that the gastric contents are not contaminated, 
and the majority of these cases are better off 
without drainage. 

Dr. Mattingly is to be congratulated on the 
presentation of an unusual and very interesting 
series of cases, and on the remarkably good judg- 
ment that must have been displayed to produce 
a death rate of only 13 per cent in patients who 
had perforated on an average 22 hours prior to 
operation. 

Dr. Mattingly (closing) : I appreciated the dis- 

cussion immensely. There is one point that should 
be stressed and that is immediate surgical in- 
tervention. I now take these cases directly from 
the Admitting Room to the Operating Room, doing 
the blood work and roentgenograms on the way. 
This series of cases was handled by the Resident 
Surgical Staff. 

HAY FEVER A SPECIALTY.* 

W. P. LAMBETH, M. D., 

Shreveport, La. 

In the treatment of hay fever one is 
confronted with many scientific problems. 
These problems, as in all branches of medi- 
cine, lead to endless amount of work, study 
and research. In fact, the field is so wide, 
literature so limited and the sections of the 
country so varied as to climate and flora, 
it becomes an individual problem in every 
section of the country. The one doing this 
work is forced to do experiments, research 
and surveys in, and about, his locality 
before he can exercise any judgment as to 
the treatment, test and diagnosis of this 
disease. In order to comply with these re- 
quirements, one has to keep abreast with 
the progress of internal medicine and allied 
branches. He must have a working knowl- 
edge of the animal and plant life in the 
community in which he wishes to practice 
this specialty. 

The men who are getting results in the 
treatment of hay fever and allergic dis- 
eases are the ones who have devoted most 

*Read before the Louisiana State Medical 
Society, Shreveport, April 29-May 1, 1930. 


24 


Lambeth — Hay Fever a Specialty 


time to the study of this disease, and the 
physician who has the time and patience 
to devote to each individual patient (any 
one suffering with hay fever is an in- 
dividual problem) as to his history and 
symptoms will most nearly arrive at a cor- 
rect diagnosis. But he must have a funda- 
mental knowledge of allergic diseases and 
keep up with the ever progressive stride of 
medical education, and have a working 
knowledge of the reaction of food and ani- 
mal emination when entering the human 
body. It is necessary to have at his disposal 
a botanical survey of the plant life of his 
particular area as well as a chart showing 
the pollen in the air at all seasons. This 
data can be obtained from United States 
Weather Bureau or by personal observation. 

Without this kind of data we are going 
to meet with failures and disappointments 
in the diagnosis and treatment; naturally 
with these disappointments go criticisms 
both from the patient and doctor, which in 
turn have their reactions on the public, 
and which throw a damper on the fellow 
who is trying to develop the field and put 
it on an educational plane. 

You will note that the subject of this 
paper is “Hay Fever a Specialty.” After 
five years of personal experience, intensive 
research and study of individual cases, 
some of which respond readily to treat- 
ment, others I have found very obstinate; 
especially so if not carefully tested and 
thoroughly treated, and from this experi- 
ence I feel justifiable in stating that this 
trouble is not an ordinary condition and 
should be handed by one with considerable 
experience. For the sake of simplicity I 
am going to classify the subject in two 
headings. 1. Hay-fever due to pollen ; 

2. Hay fever due to other causes. In 
making this classification I do not wish to 
create the impression that pollen hay-fever 
is sharply differentiated from other types, 
because it is a fact that a great percentage 
of patients sensitive to pollen are also sensi- 
tive to other substances. At present, the 
physio-chemical reaction of the materials 


that cause hyper-sensitiveness in indivi- 
duals is not so clearly understood that we 
can make a sharp differential classification. 
I do want to emphasize that the whole field 
of allergic diseases as to cause, symptoms 
and treatments must be considered before 
attempting any classification. 

I will not take up your time in going into 
the various branches of hay-fever and aller- 
gic diseases, but will consider only what we 
call hay-fever proper, or hay-fever due to 
the pollen of plants, as there are certain 
seasonal variations in the pollination of 
plants. I make the following classification : 

1. Winter — pollen from trees as cedar 
and elm. 

2. Spring — a. Trees — oak, box elder, 

cotton wood, elm, walnut. 

b. Grass — blue grass, orchard grass, 
timothy. 

c. Weeds — red sorrel, lambs quarter, 
dacar. 

3. Summer — grass — Johnson grass, 

Bermuda grass and a few weeds. 

4. Fall — rag weed group. Most import- 

ant of these giant, short, marsh 
elder, cocklebur. 

In making this classification as to the 
study of hay-fever and treating the 
diseases, it is supposed that one knows 
enough about botany to differentiate some 
of the families of grasses and weeds and 
be able to locate certain weeds in a group 
or family. One also must know the geo- 
graphic distribution of these plants and 
their time of pollination, as well as when 
and how to gather pollen for treatment. It 
is also necessary to know how to plate and 
count pollen from the air and how to dif- 
ferentiate the pollen. These facts require 
quite an extensive botanical survey and it 
is almost impossible for an individual prac- 
ticing medicine to accomplish this single 
handed, but with the aid of an able botanist 
he can in time assimilate all the data neces- 


Lambeth — Hay Fever a Specialty 


25 


sary to make the next important step — a 
diagnosis. 

In order to arrive at a diagnosis it will be 
necessary to mention certain points of tech- 
nic which I classify under the following 
headings: 1. Patient’s history; 2. botani- 
cal survey; 3. skin test; 4. reproduction 
of the disease. Under patient’s history, 
I try to get (a) fami’y characteristics; 
(b) symptoms of the disease; (c) season 
and duration of illness. Botanical survey — 
I determine (a) the plant life in the com- 
munity from which the patient comes, (b) 
season of pollination and pollen found in 
the air. Skin test should be made after 
this information is determined and tested 
only with substances found to be present at 
the time patient has symptoms. This state- 
ment refers only to pollen. Food and ani- 
mal emination is dealt with separately, de- 
pending on history of patient. The disease 
may be reproduced at any time by bringing 
patient in contact with the substance found. 
From this technic the diagnosis is fairly 
simple, because from the history and symp- 
toms I know the patient has hay-fever, also 
the season of the year the patient suffers, 
and I know certain plants pollenating at 
that time. This information being the key 
to my diagnosis, I proceed to make the test 
with pollen found in the air at that season 
and from the plants growing in the locality 
and pollenating at that time. For instance, 
I have a patient in Shreveport giving a his- 
tory of hay-fever during the months of July 
and August. From experience I know that 
Johnson grass is pollenating and can plate 
it from the air during this season. I pro- 
ceed to make a skin test with Johnson grass 
pollen and get a 3 plus reaction with the 
usual area of hyperemia, a raised center 
with pseudopods, and can produce the 
disease by mopping the nasal cavity with 
some of the pollen ; therefore I say that this 
patient is sensitive to Johnson grass 
pollen and most likely her trouble is due 
entirely to this cause. 

After the diagnosis has been established 
by the e’iminative technic it will be wise 


to consider the treatment under the follow- 
ing headings: 1. Pollen extract. 2. Ultra 
vio’et radiation. 3. Drugs. 4. Surgery. 
Since the illness is due to Johnson grass, 
I make a 5 per cent stock solution in gly- 
cerine and saline. From the stock solution, 
dilutions for treatment are made, which 
run from a 5 per cent so’ution to a 1-50,000 
solution. Also I find the patient is sensitive 
to, say three weeds of the same family, 
reactions running 1 plus, two plus, three 
plus, I make a 5 per cent extract of each of 
the three pollen and make a solution in pro- 
portion, as — 1 c.c. of one plus, 2 c.c. of two 
plus, and 3 c.c. of three plus, then make 
from this percentage mixture dilutions for 
treatment. 

The technic of treatment with pollen ex- 
tract requires close personal observation 
of your patient. In the first place we are 
dealing with a powerful drug insofar as 
this individual is concerned. In the second 
place you must have such a drug if you 
expect to get any appreciable relief. The 
theory of this treatment is to build up the 
resistance in your patient with your pollen 
solutions to a higher degree than the 
patient meets with normally. If you can do 
this and your pollen extract contains all the 
pollen the patient is sensitive to, you can 
expect relief. You need not expect relief 
if you use the 15 dose drug store package. 
The treatment should be given in increas- 
ing dosage every other day, but you must 
remember that the dose today depends on 
reaction of previous dose. There are sev- 
ral factors at this point to be considered, 
and can be determined only by personal 
observation of your natient, a knowledge 
of the reactions of pollen extract and your 
pollen chart. A high pohen count and a 
four plus reaction from previous treatment 
will caut'on you as to the increase in dos- 
age. 

Ultra violet radiation, in my opinion, will 
help the cause and should be used both 
local'y and general. This form of therapy 
is not thoroughly understood but is being 


26 


Lambeth — Hay Fever a Specialty 


used with considerable relief to the patient ; 
I believe only symptomatically. 

The question of drugs will have to be con- 
sidered (1) because drug therapy in pre- 
vious years has always made the patient 
worse. (2) Because only a mild oily pre- 
paration should ever be used in the nose. 
(3) Because it is necessary at times to use 
such drugs as adrenalin, ephredin and 
atropin for symptomatic relief. 

Surgery — In recent years the tendency 
of most rhinologists has been to get away 
from nasal surgery in hypersensitive indi- 
viduals. Nasal surgery on these patients 
frequently leads to more pronounced symp- 
toms with permanent anatomical and patho- 
logical lesions. The anatomy and physi- 
ology of the nose is very essential to the 
human body and should be left intact. We 
have our nerves of the sense of smell, our 
blood vessels and epithelial cells for warm- 
ing and moistening the air that enters the 
lungs. Anything that tends to impair this 
function leads to more pronounced symp- 
toms of the disease and often with an exten- 
sion of the trouble into the bronchial tree 
and asthma. 

The old saying, “The doctor buries his 
mistakes,” does not work here. In spite of 
their suffering and agony these asthmatics 
do not die, but continue calling on the doc- 
tor for relief, and mostly at late hours of 
the night. They continue their faithful 
treatment with their doctor until all sym- 
pathy is lost, when they seek relief from 
the various advertisements and quacks. 
These individuals finally settle on some nos- 
trum for relief and continue blaming the 
surgeon for their troubles. 

It is not uncommon for an asthmatic to 
give a history of a mild type of hay-fever 
for a few weeks in summer prior to oper- 
ative procedure, but after the nose oper- 
ation the hay-fever became worse, and 
asthmatic attacks begin to occur at any sea- 
son of the year. But in spite of these con- 
ditions we find patients where surgical 
treatment is necessary. In chronic cases 


where the secretions are being dammed up, 
allowing bacteria and pus to enter the sin- 
uses, we must have drainage. Any further 
surgical procedure often times leads to sor- 
row. 

In conclusion will say that since you have 
learned the fundamental principles of hay- 
fever, having given the subject a thorough 
consideration, as to the study of botany and 
the distribution of plants, the methods in 
which pollen may enter the human body 
and the interpretation of the skin test. 
Having fixed in your mind the basic prin- 
ciples of allergic diseases and the differen- 
tial diagnosis of internal medicine, you 
should have as good results in treating hay- 
fever as any other branch of medicine. But 
to attempt to treat hay-fever without obtain- 
ing this information you are bound to meet 
with disappointment which will cast an- 
other shadow over this field — “Hay Fever a 
Specialty.” 

DISCUSSION. 

Dr. B. G. Efron (New Orleans, La.) : I entirely 

agree with the absolute necessity of a pollen sur- 
vey before doing anything with hay fever. We 
have found in a pollen survey of New Orleans 
started two years ago and finished now the pre- 
valence of a tremendous number of weeds, some- 
thing like fifty grasses and other weeds. In New 
Orleans we have very little frost and pollens can 
cause hay fever in all seasons of the year. 

However, I have personally found after rather 
an extensive experience with hay fever that the 
skin tests are often unreliable, and in a paper 
about to be published I have devised an entirely 
new method which the essayist has discussed, 
namely, the nasal method. We believe we have 
definitely proven that the skin tests while valuable 
in some instances are practically useless in many 
other cases. 

For example, in the series of twenty continuous 
cases of fall hay fever we have found that marsh 
elder in only one instance produced hay fever 
symptoms when dry pollen was sprayed in the 
nose, whereas the skin reactions were often posi- 
tive. Cockelbur produced symptoms to a mild 
degree in only thirty-three and one-third per cent 
of the cases, but in all cases except one it pro- 
duced symptoms in individuals who reacted mark- 
edly with ragweed pollen. 

Furthermore, usually whenever an individual 
reacts to one ragweed, he reacts to the other rag- 


Lambeth — Hay Fever a Specialty 


27 


weed. We found in this series of cases that nine- 
teen out of these twenty who reacted to ragweed, 
reacted to one as well as the other, but in one 
case the individual reacted only to the large rag- 
weed and did not react to the small ragweed. In 
only two cases were we unable to reproduce symp- 
toms in individuals who have seasonal hay fever. 

We have used an adequate number of controls, 
and we know that pollen sprayed into the nose of 
a normal, not hypersensitive individual will not 
produce hay fever symptoms. Allergic patients 
are sensitive to the things that are innocuous to 
the great number of people in the community. 

Another point brought out by the essayist is 
the question of treatment. Many allergists be- 
lieve that if you use one grass it will protect 
against all grasses. There is no doubt that col- 
ateral protection exists, but I believe that the best 
results will be obtained when specific antigens 
are used. 

Also, we have found that although the skin tests 
can give a three plus to Johnson grass, two plus 
to Bermuda, and one plus to wormwood, if you 
spray the pollen you find the wormwood may give 
the symptoms and the other two pollens do not 
give symptoms. 

Results have so far been very encouraging, and 
I believe that the amount of relief given justifies 
further research on this ever increasing problem 
because it is becoming a question of tremendous 
importance. 

Dr. Martin (Donaldsonville, La.) : Hay fever, 

in my humble opinion, is a case where we have the 
cart before the horse by using pollen injections 
in the treatment. I don’t believe there is a single 
case of hay fever that does not have an infection 
or an obstruction in the nose before they have 
hay fever. I heartily disagree with the doctor 
on the surgical treatment of hay fever. 

Being on the staff at the Charity Hospital on 
ear, nose and throat, just across the hall from 
Dr. Thiberge, I have the opportunity of seeing hun- 
dreds of cases of hay fever, and I have yet to see 
one single case of hay fever where I did not see 
pus trickling down from some of the sinuses of 
the nose. If these sinuses are properly cleansed 
and the infection is gotten rid of, you are going 
to get rid of your hay fever, and if you don’t do 
that you are not going to get rid of your hay 
fever. You will have it as long as you live regard- 
less of how many pollen injections you take. 

Why not try to clean the sinuses out as they 
should be cleaned? There is where the problem 
lies. We operate on them and operate on them, 
and they come back to us with the hay fever. We 
relieve them. Some cases we cure. Those where 


they are able to clear up the infection are cured, 
but in my opinion if the infection is not cleared 
up either by treatment or operation the hay fever 
will never be permanently cured by pollen in- 
jection. Being personally a sufferer of hay fever, 
I know I have an obstruction in the nose; I know 
I have a sinus infection. When my sinus flares 
up, my hay fever starts. I have taken the treat- 
ment. It gives me relief, but it certainly will 
not cure me if I don’t get rid of the sinus infection. 

Dr. R. McG. Carruth (New Roads, La.) : While 

I have never specialized alone the lines indicated 
in the treatment of hay fever, yet as a general 
practitioner for half a century, I have noted its 
steady and uninterrupted growth and spread. 
Whether in various individuals, it be due to pollen 
or to emenations from s many different things, 
stables, chickens, and other animals that we have 
an idiosyncrasy for, I believe the main fault lies 
with the patient. That makes me agree, to a great 
extent, with Dr. Martin, who just preceded me. 

A little more than ten years ago I read a paper 
in this city on the subject of race degeneration. 
I said in that paper that the genus homo, especially 
the white race was going the way of the Egyptians, 
the Babylonians and the Sumerians. Very recent- 
ly, Mr. Stanton Coblentz, in his work, The Decline 
of Man, says that we are going the way of the 
dinosaur, the ichthyosaur, the tyrannosaur, the 
sabre toothed tiger and other extinct animals that 
have outlived their usefulness according to the 
great scheme, and lost their ability to adjust them- 
selves to changing conditions. There seems to be 
something in every race, in every species, that 
has within it that which makes for its own destruc- 
tion. By our rapid advances the last few years, 
due to our inventive genius and our wonderful 
scientific achievements, our civilization has built 
up a vast machine, mechanical and industrial, the 
various parts of which have been adjusted so 
thoroughly to themselves that they move with the 
accuracy of a Swiss watch, but we have signally 
failed to adjust ourselves to this machine. The 
social order has fallen to pieces and we are awak- 
ening to the fact that we have constructed a great 
Frankenstein monster that is turning upon us and 
devouring us. 

Whether there is a way out, I do not know. I 
believe if there ever is a cure discovered, or an 
amelioration for hay fever, it will be along the 
lines indicated by the science of endocrinology. 
We have outrun our endocrines; we seem to have 
reached a senescent stage, and unless we inaugu- 
rate most radical changes in our habits of life, a 
complete reorganization of our industrial, com- 
mercial, educational and social systems, our civili- 
zation is wrecked and the final doom of the white 
race is assured. 


28 


Weiner — Non-Urologic Symptoms Due to Urinary Lesions 


Dr. W. P. Lambeth (closing) : In listening to 
this discussion on hay fever, I agree with all these 
fellows that it is a very difficult thing to work out. 
Some fellows have different ideas as to technic. 

The first fellow mentioned that the skin test 
wasn’t of much value. I say there is no one thing 
in hay fever that is of much value in diagnosis. 
Remember what I told you, study all this question 
of hay fever, and allergic disease, and all the tests 
and researches that you have, and you will eventu- 
ally come to a diagnosis. 

I will say this, too : Once you have any condition 
of the nose that is considered more or less of a 
serious pathological condition, I don’t believe that 
nose ever gets 100 per cent well. The only cases 
that I have condemned are those on which the sur- 
geons have operated on the nose. 

I will read you this point: “It is not uncommon 
for an asthmatic to give a history of a mild type of 
hay fever for a few weeks in the summer prior to 
operative procedure, but after the operation on 
the nose the hay fever became worse. The asth- 
maticks attacks, began to occur at any season of the 
year, but in spite of these conditions we find a 
patient where surgical treatment is necessary, and 
I recommend only drainage.” 

Dr. Martin: Have you ever seen a case of hay 

fever get entirely well? 

Dr. Lambeth: I just made that point, that I 
never have. 


NON-UROLOGIC SYMPTOMS DUE TO 
URINARY LESIONS.* 

E. WEINER, M. D. 

Alexandria, La. 

How often the urinary tract is over- 
looked in the consideration of intra- 
abdominal symptoms is made clear when 
we observe (1) that in a series of 50 cases 
reported by Hunner, 34 had been operated 
previously, and of these 27 were not re- 
lieved of their symptoms. Four of the 27 
had each had three operations, without 
improvement. Walther reported a series 
of 13 cases, 9 of whom had been operated 
previously for various complaints, 5 of 
them twice, without relief. There are 
others who report similar experiences. 
One is almost certain to miss, in many 
vague abdominal cases, the proper diag- 

*Read before the Rapides Parish Medical 
Society, November 3, 1930. 


nostic trail unless both the frequency of 
the lesion and the protean manifestations 
are constantly borne in mind. One rarely 
recognizes a thing about which one does 
not think or for which one does not seek. 

Some of the lesions, symptoms of which 
may be very confusing with other intra- 
abdominal conditions, are the following: 
Stricture of the ureter ; ureteral kinks 
(due to inflammatory bands and nephrop- 
tosis) ; obstruction caused by pressure on 
the ureter by abnormally placed vessels 
(aberrant vessels) ; ureteral and kidney 
stones ; hydronephrosis ; all infections of 
the urinary tract such as pyelitis, pyelo- 
nephritis, pyonephrosis, perinephritic ab- 
scess, ureteritis, cystitis, etc. ; movable 
kidney ; tumors and tuberculosis of the 
kidney; polycystic disease of the kidneys; 
and others. 

As an explanation of some of the con- 
fusing symptoms to which lesions within 
the urinary tract may give rise, we should 
remember that embryologically the urinary 
tract from the kidney to the urethra is 
one continuous tube; that the innervation 
of this tract is derived from the sympa- 
thetic system and is in intimate associa- 
tion with the nerves supplying practically 
a(l organs within the abdominal and pel- 
vic cavities (2). These simple facts serve 
as a basis of explanation for the fre- 
quency with which urinary lesions may be 
confused with symptoms which seem to 
arise from other organs. The pain of 
renal or ureteral stone reflected to blad- 
der, testicle, or penis, is the common 
knowledge of all; by the same token any 
urinary lesions other than stone may be 
and often is mirrored in bladder, urethra, 
or one of the pelvic or abdominal organs. 
Vesical frequency or irritation no more 
connotes vesical inflammation than does 
nausea or vomiting indicate gastritis. 

One of the very frequent conditions of 
the urinary tract which is often overlooked 
is stricture of the ureter. This is a com- 
mon pathological condition that should be 
of interest to every medical man. Patients 


Weiner — Non-Urologic Symptoms Due to Urinary Lesions 


29 


suffering with this lesion are frequently 
seen by every active physician, whether he 
be engaged in general medicine or one of 
the specialties. Usually these patients 
first consult the family physician. 

The symptoms of ureteral stricture or 
other ureteral obstruction are very vari- 
able but pain in the abdomen or back 
and frequency of urination and dysuria 
are the most frequent complaints. So 
many of these cases are referred to the 
general surgeon because the symptoms 
may simulate exactly those of appendicitis 
or gall bladder pathology, or other surgi- 
cal condition of the abdomen. Often the 
pain is in the pelvic region and is asso- 
ciated with low backache and dysmenor- 
rhea, and so many of these cases go to the 
gynecologist. Stricture patients usually 
have an exacerbation of symptoms during 
pregnancy and obstetricians have to deal 
with the conditions. Again, the gastro- 
intestinal disturbances are the most promi- 
nent features and the patients are sent to 
the gastro-enterologists. Pain due to 
ureteral stricture is often referred to the 
sacro-iliac, hip, and thigh regions, and 
therefore the advice of the orthopedists is 
sometimes sought. The ophthalmologists 
are often called upon to relieve headache, 
which is frequently a common complaint. 
Neurologists see many of these patients, 
who after a long period of suffering have 
developed neurological symptoms. 

It is sometimes possible to make a ten- 
tative diagnosis of ureteral stricture or 
other ureteral obstruction from the history 
and physical findings ; but, the ultimate 
diagnosis must, of course, be made by 
cystoscopic methods with the use of the 
roentgen-ray (3). The manifestations of 
this condition as those of many other 
urinary lesions are so varied that when- 
ever one is in doubt as to the exact diag- 
nosis of an abdominal or pelvic complaint, 
recourse should be had to a complete uro- 
logic investigation for the purpose of at 
least ruling out a possible urinary lesion. 


In infants, as in adults, urinary stasis 
predisposes to, and perpetuates infection 
of the urinary tract. Stasis is predomi- 
nantly the result of obstruction, and in 
infants the majority of urinary obstruc- 
tions are found along the course of the 
ureter. 

The clinical picture is varied and is 
quite apt to be misleading. Lumbar pain, 
loin ache, renal colic, hematuria, dysuria, 
and frequency are uncommon, or are at 
any rate, symptoms difficult to elicit and 
evaluate in children. Commonly, the clini- 
cal picture is that of so-called “acute pye- 
litis,” complicated by an upper respira- 
tory infection, or a gastro-intestinal upset. 
Without repeated urinalysis and usually 
a urologic study, a diagnosis cannot be 
made. From the history, onset, and clini- 
cal observations, one cannot differentiate 
this condition from early pneumonia, men- 
ingitis, encephalitis, otitis, influenza, or 
any of the acute infections of childhood. 
A persistent or recurring pyuria is signi- 
ficant. Approximately 2 per cent (4) of 
infants suffer from ureteral obstructions 
which predisposes to infection and renal 
destruction. In adults the percentage is 
higher. Therefore, it is important that 
all cases of persistent pyuria be given a 
complete urologic investigation. 

We shall just mention a few of the 
other urological conditions which may be 
mistaken for diseases of other organs. 
Urolithiasis may cause pain anywhere 
along the urinary tract, and also referred 
pain to any other abdominal or pelvic vis- 
cera. There may be vomiting, dyspepsia, 
fever, and, in children, often diarrhea. 
There is not always blood in the urine, nor 
a pyuria. It is a condition that should 
always be looked out for in abdominal or 
back pains. However, there are some 
cases, the so-balled “silent” stones, in which 
there are no symptoms. In childhood 
urinary stones occur fairly frequently. 
Holt reports small stones frequently voided 
during the first two years of life, and 
in a study of a thousand autopsies 


30 


Weiner — Non-Urologic Symptoms Due to Urinary Lesions 


found calculi quite common in infants (5). 
Unquestionably such conditions o'ccur more 
frequently than reports in the litera- 
ture would indicate. Everything has its 
beginning, and too often conditions are not 
recognized in early life, which when 
allowed to exist cause irreparable func- 
tional and organic damage by the time 
adult life is reached and a diagnosis is 
made. Any child with an obscure abdomi- 
nal compfaint, especially if it be pain, 
should at least have the benefit of urin- 
alysis and roentgen-ray examination, as 
the majority of cases of urinary calculus 
would be revealed. 

Acute right-sided pyelitis is frequently 
mistaken for appendicitis (6), and not in- 
frequently operations are unwisely under- 
taken because insufficient attention is paid 
to the symptoms. The points in differen- 
tial diagnosis can be tabulated as follows: 

Acute Pyelitis. 

1. Initial rigor — the rule. 

2. Temperature 103 degrees or more. 

3. Pain on micturition. 

4. Increased frequency of urination. 

5. Pus in urine. 

Appendicitis. 

1. Rigor unusual. 

2. Temperature as high as 103 degrees 
uncommon. 

3. Urinary symptoms inconstant. 

4. Local rigidity frequent. 

5. No pus in urine. 

However, one must remember that both 
conditions may be present at the same 
time. Also, pyuria may only be a sign of 
a more serious lesion such as pyelone- 
phritis, pyonephrosis, renal tuberculosis 
or tumor; or, the pyuria may be secon- 
dary to a urinary calculus or some ob- 
struction in the urinary tract. 

Acute right-sided hydronephrosis is 
sometimes misdiagnosed appendicitis with 
abscess formation. There are usually 
urinary symptoms, such as scanty urine, 


pain during or frequency of urination, 
etc. There may be swelling in the lateral 
aspect of the abdomen and well back in 
the loin. In acute pyonephrosis a similar 
swelling may occur, but it is usually more 
tender, more fixed, and the general signs 
of constitutional disturbance are much 
greater. There is usually pus in the 
urine. This condition is easily diagnosed 
as a rule, by means of pyelography. 

Movable kidney is a condition which is 
occasionally seen, and which may give rise 
to doubts in the diagnosis. A kinking of 
the reno-ureteric junction may occur and 
cause severe pain in the loin (“Dietl’s 
crises”), and a diminution of the amount 
of urinary secretion, without much swell- 
ing of the kidney. The urinary symptoms, 
lack of fever, and relief of the pain when 
urine passes more freely, may serve to 
distinguish it from other conditions. Other 
symptoms are largely gastro-intestinal, 
and often described as “indigestion” : 
anorexia, belching and distention, consti- 
pation or diarrhea, and nausea and vomit- 
ing. So, one must be careful not to call 
this condition a gastro-intestinal one. 

Neoplasms of the urogenital tract may 
also be mistaken for other conditions; also, 
tuberculosis of the kidney. These condi- 
tions can only be definitely diagnosed by 
means of cystoscopy with ureteral cathet- 
erization and pyelography. The most 
common symptoms of these conditions are 
hematuria and pain. 

Finally, one must be on the lookout for 
polycystic disease of the kidneys. This 
condition may give rise to uremia, with 
vomiting and abdominal distention. This 
might be mistaken for intestinal obstruc- 
tion, but the presence of tumors in both 
loins and the occurrence of albuminuria 
and high blood pressure would make one 
suspicious. The pyelographic study of 
both kidneys would clinch the diagnosis. 

CONCLUSION. 

I would again impress upon you the 
importance of keeping the various urinary 
lesions in mind whenever dealing with a 


Wood — Malaria: Cause, Misdiagnosis, Treatment and Prevention 


31 


vague or obscure condition in the abdomi- 
nal or pelvic cavities. Urinary lesions 
may give rise to such a varied clinical 
manifestation that almost any condition 
may be simulated. It is imperative that 
all of these doubtful cases be given the 
benefit of a complete urologic study before 
surgical means are employed, or before a 
possible serious lesion of the urinary tract 
becomes irreparable. 

BIBLIOGRAPHY. 

1. Sparks, A. J. : The urinary tract and intra-abdominal 

symptoms (case reports), J. Indiana Med. Ass. 21:376-78, 
1928. 

2. Baker, J. N. : Stricture of the ureter. Am. J. Surg. 
3:6-12, 1927. 

3. Ginsberg, H. M. : Symptoms of obstruction and their 
simulation of abdominal diseases requiring operation, M. J. 
& Rec. 128:211-213, 1928. 

4. Campbell, M. F. and Lyttle, J. D. : Ureteral obstruc- 

tion in infanry; study of 74 lases, Tr. Sect, Dis. child, A. 
M. A. pp. 135-149, 1928; also, J. A. M. A. 92:544-550, 1929. 

5. Brown, D. A.: Renal and ureteral calculi in child- 
hood with case report, J. Urol. 18:285-291, 1927. 

6. Cope, Zachary : The early diagnosis of the acute ab- 
domen, Humphrey Milford Oxford University Press, Lon- 
don, 5th Edition, 1928. 


MALARIA : 

Cause, Misdiagnosis, Treatment and 
Prevention.* 

g. H. WOOD, M. D., 

Batesville, Miss. 

Any disease which occupies first place in 
a community or state in point of numbers, 
with a large death rate, should be frequently 
discussed. 

It is not my desire to take up your time 
by an exhaustive review of the literature, 
for I am sure the work done by Laveran, 
Ross, Machiafavi, Bignami, Bass and others 
is familiar to each of you. It is, however, 
necessary to quote from these men to have a 
clear idea of the infection and a correct 
method of treatment. 

While there are several points of the life 
cycle of the parasites not thoroughly worked 


*Read before the North Mississippi .Six County 
Medical Society, Water Valley, July 16, 1930. 


out, the gross fact remains that malaria is 
caused by the malarial plasmodium. To 
make it as simple as possible, we must first 
realize this is a haemameba; that in cases 
of malaria it appears in three forms : ter- 
tian, quartan, estivo-autumnal ; that it has 
two forms of development : the asexual and 
the sexual. 

The development is almost the same in all 
three forms. In the human hosts, the 
asexual forms develop that which is 
simply a reproduction of like and can not 
be transmitted to other individuals, unless a 
quantity of blood is injected from one 
person to another. And for the propaga- 
tion of more parasites for other individuals, 
we must have the sexual forms developed in 
the anopheline mosquitoes. 

We frequently have two or three groups 
of parasites in the same individual, giving 
rise to what is known as double tertian or 
quartan fever. 

It is usually accepted that the fever is 
caused by a liberation of toxin at the time 
of sporulation. The time of sporulation or 
segmentation for tertian type is 48 hours; 
for quartan 72 hours; for estivo-autumnal 
24 to 48 hours. 

It is well to keep in mind the various 
stages of development and not be confused 
by the different terms used. When the 
parasite first attack the red cell or erythro- 
cyte, it is called sporozoite or merozoite. 
As soon as it enters the erythrocyte it is 
called a hyaline body. By some, up to the 
time of segmentation, it is called schizont; 
after segmentation it becomes sporozoite or 
merozoite and gamete or gametocyte. The 
gametes are microgametes (male) and ma- 
crogametes (female) . The sporozoites are 
then ready to attack other cells and per- 
petuate life cycle. 

For the sexual form the mosquito takes 
up the gametes and after the macrogamete 
become fertilized in the mosquito’s stomach 
it is called zygote, which develops into a cyst 
and is now called oocyst. Finally, small 


32 


Wood — Malaria: Cause, Misdiagnosis, Treatment and Prevention 


spindle shaped bodies develop. These are 
known as sporozoite. This development re- 
quires 15 to 25 days, after which time, if 
the mosquito bites an individual, he becomes 
infected by the sporozoite and the process of 
asexual development begins. 

The important point not cleared up is 
why some cases of severe infection should 
develop what is known as haemoglobinuria. 

Fortunately, by looking after the cases 
early, this condition is less frequent than it 
was some years ago. I have not seen a 
case in several years. 

So far as cause, treatment and preven- 
tion, I am sure hardly any major disease 
is better understood than malaria. Still, for 
the diagnostician, who does not rely on 
blood tests, many errors will be made. 
This is easily accounted for when you 
realize that no disease is a barrier to mala- 
rial infection. 

More errors are made by calling other 
diseases ma'aria than by calling malaria 
other diseases. I do not believe that any 
diagnosis of malaria should be accepted 
unless the blood examination is positive. 
Repeated tests should be made if the report 
is negative. Too many are satisfied with 
one test or rone. Every death certificate, 
which has malaria as the cause of death, 
should state whether or not blood tests were 
pos’tive. 

One reason for many death certificates 
havirg malaria given the cause of death, it 
prevents further correspondence from the 
Bureau of Vital Statistics, as they want 
every death certificate to correspond with 
the International List of causes of death. 

While every disease, which gives a rigor, 
accompanied by fever of an intermittent or 
remittent type has been called malaria, 
there is now in the state what is called un- 
dulant fever, which is more likely to be 
treated for malaria than any other disease. 
Blood tests and time together will be neces- 
sary to clear the diagnosis. 


In regard to diagnosis of latent malaria 
or malaria complicated with other diseases, 
Dr. C. Dozzi, Policlinico, Roma, states that 
if he used one milligam of adrenalin hypo- 
demically after omitting quinine for five 
days, the parasites began to show in the 
peripheral blood in 20 minutes, were at 
their best in one hour and had disappeared 
in 24 hours. He used this method in 20 cases 
and all cases proved positive. As some 
medicines, such as quinine, drive the para- 
sites from the periphery, I see no reason 
why some other drug might not be success- 
ful in driving them to the periphery. 

More attention should be given the time 
of taking blood smears. Dr. Graham E. 
Henson, Jacksonville, Fla., states: “In the 

benign tertian sporulation occurs princi- 
pally in the deep circulation and the 
majority of schizonts seek the deepest tis- 
sues a few hours before this cycle is 
reached, the young merozoites f oho wing 
sporulation do not at once inhabit the 
peripheral circulation, so that the best time 
to take blood smears for the detection of 
the benign tertian parasite is from 4 to 6 
hours after the chill, and for the succeeding 
hours to within 6 hours of anticipated 
sporulation.” 

In the quartan infection sporulation 
occurs more often in the peripheral cir- 
culation than in any other forms of the 
disease, and on this account the parasite is 
more easy of detection in the peripheral 
circulation throughout the entire cycle, so 
that the time of taking a smear is not so 
important. 

For the estivo-autumnal, two hours after 
the chill or exacerbation and for the suc- 
ceeding two or three hours, are best. After 
the infection has persisted long enough to 
a' low the forming of crescents, a smear may 
be taken at any time.” 

It is still claimed by some practitioners 
that quinine properly given will cure every 
case of malaria. That gives a nice loop 


Wood — Malaria: Cause, Misdiagnosis, Treatment and Prevention 


33 


hole to question the giving of the drug. 
There are numbers of good clinicians who 
realize that quinine, like every thing else, 
has its limitations; in other words, some 
cases will not be cured by quinine alone. 
The standard treatment, as it is called, has 
done a great deal of good, possibly as much 
by calling the people’s attention to the 
necessity of taking quinine as a prevention 
of malaria and not to rely so much on so- 
called patent medicines, chill and malarial 
cures. The treatment must be varied to 
suit the individual case. Many ears have 
been injured by giving quinine in too heavy 
doses and continuing too long. 

Some have followed the plan outlined by 
Dr. A. J. Ochner some years ago, which is 
the standard, only using smaller doses. I 
frequently supplement the quinine by in- 
jection of cacodylate of soda twice a week. 
Frequently there are cases where a bitter 
tonic, like Warburg’s tincture, given two or 
three times a day and given five or six days 
as if expecting to keep the chill off next 
day, is of value. 

My experience with plasmochin has been 
quite limited. 

I saw Dr. Krauss’ demonstration of its 
use before it was put on the market and 
he was quite enthusiastic about its effect on 
special cases. 

At the symposium on malaria in Miami, 
Fla., November, 1929, Dr. W. E. Deeks, in 
quoting observations by Dr. H. C. Clark, 
Dr. M. A. Baker, Dr. W. Cordes, Dr. E. R. 
Whitmore, Dr. H. W. Komp, leave little 
room for doubt that quinine has no effect on 
the development of mature stages of the 
gametocytes nor does it interfere with the 
infectiveness to the moquitoes. This applies 
particularly to the estivo-autumnal parasite. 


The effect of plasmochin on the crescents, 
however, is a different story, as it does what 
quinine and its salts failed to do. It devi- 
talizes the gametocytes, so that patients 
who have received a sufficient dosage of 
this drug are not infective to mosquitoes. 

This property which plasmochin possesses 
makes the discovery of the drug one of the 
greatest advances in recent years in mala- 
rial control. 

All of which seems to emphasize the 
necessity for more blood study in order to 
prescribe quinine and plasmochin as neces- 
sary without adhering blindly to one treat- 
ment, if it is called standard. 

Preventing malaria is summed up in a 
few words: “Keep the mosquitoes from 

biting you.” All other causes may be dis- 
regarded, as evidently no case was ever 
produced by what we eat or drink. 

If there is infection in the blood, what- 
ever can lower vitality may help produce 
the paroxysm. Some one, I believe it was 
Dr. Bass, prophesied that Mississippi would 
be free from malaria in 1935 or 1940. I 
believe he will have to extend the time to 
something like 2000. 

As the disease grows less the harder it 
will be to get people to observe the neces- 
sary precautions, especially where there is 
an item of expense. 

In every county with a whole-time health 
unit, the problem is easier, because of re- 
peated blood tests of all the people to find 
out those actually infected and the con- 
tinuous campaign against mosquito breed- 
ing p’aces. 

If you must have mosquitoes about your 
premises be extra careful about your 
visitors, so that you will not get your mos- 
quitoes infected. 


34 


Strain-0 ’ Mara — Agranulocytic Angina 


AGRANULOCYTIC ANGINA 
With Case Report.* 

S. F. STRAIN, M. D., 

AND 

B. B. O’MARA, M. D., 

Sanatorium, Miss. 

Agranulocytic angina is a rather rare 
disease or synfcrome characterized by a 
sudden onset oft high, prostrating fever, 
and other symptoms of an acute systemic 
infection, usuajfy associated with a severe, 
necrotic ulceration of the tonsils and 
pharynx, often including the mucous mem- 
branes of the gastro-intestinal tract, the 
lips, gums, tongue, the vagina, anus and 
the skin, with a marked reduction or com- 
plete absence of granulocytes, terminating 
fatally in most instances. 

To Schultz 1 is generally accorded the dis- 
tinction of having first thoroughly de- 
scribed the condition and giving it the 
name agranulocytosis, but several case re- 
ports of what was undoubtedly this con- 
dition had previously appeared in the 
literature. Schwartz 2 described a case in 
1904, and Turk 3 another in 1907. The first 
appearance of the subject in American 
literature was a case report by Lovett 4 in 
1924. Altogether there have been over two 
hundred cases reported, principally in 
America, Germany and Austria, with a 
few from England, France, Scandinavia 
and Japan. 

The condition seems to be either on the 
increase or else we have been making more 
accurate diagnosis recently. So far as we 
have been able to discover, our case is 
the first that has ever been reported in 
Mississippi. 

The term agranulocytic angina as sug- 
gested by Friedmann 5 has been criticized. 
Not all cases have angina, hence the name 
agranu’ocytosis, given the condition by 
Schultz. Schilling 6 suggested the name 

*Read before the Central Medical Society, Jack- 
son, Miss., September 16, 1930. 


malignant neutropenia, since “the term 
agranulocytosis is incorrect: By agranulo- 
cytosis is meant an increase in atypical 
neutrophiles (‘agranulocytes’) which is not 
intended.” 

ETIOLOGY. 

The etiology is not known. There is a 
difference of opinion among the various 
authors as to whether the condition is a 
specific disease entity, a granuloleukopoietic 
disorder of the bone marrrow, or whether 
it is the result of (a) a chemical poisoning, 
or (b) some chronic disease, diseases or 
infections. While it has been noted in both 
sexes and between the ages of 2 week to 
66 years, 6 it is a great deal more common 
in women (90 per cent of reported cases) 
between the ages of 40 and 60 years. It 
frequently has its onset while the patient’s 
health is weakened by some chronic illness 
as hypertension, chronic gall bladder dis- 
ease, tuberculosis, et cetera, or it may occur 
in individuals who at the time seem other- 
wise to be in good health. Cases have been 
reported following the extraction of teeth, 
sinus and throat operations, and fractures. 
Numerous organisms have been obtained 
from cases by direct smear from the lesions, 
or by blood culture, the more common being 
streptococcus hemolyticus, S. virdans, Vin- 
cent’s organisms, bacillus pyocyaneous, 
B. coli, Staphylococcus aureus, and others. 
Potts 7 concludes that agranulocytosis “is not 
an independent disease, but represents a 
variety of septic illnesses,” and says that 
it should be considered a symptom-com- 
plex and “designated as ‘sepsis agranu- 
locytotica.’ ” Schultz 8 suggests that the 
cause may be the toxic action of some 
virus which has a special affinity for the 
myeloid system. Rosenthal 8 considers that 
agranulocytosis is a clinical entity, related 
in some instances to a constitutional hypo- 
plasia of the leukopoietic system; in other 
cases it may be the result of transitory 
hypoplasia. Pepper 9 noted four cases in 
allergic patients, points out that anaphylac- 
tic reactions include leukopenia and inquires 
whether this syndrome might not be an 


Strain-O’Mara — Agranulocytic Angina 


35 


allergic manifestation. Other factors sug- 
gested in the etiology are that the condition 
is secondary to some endocrine influence, 
and that it is a malignant leukopenia of 
leukemic nature. We are inclined to be- 
lieve from a rather extensive survey of the 
literature that there are several diseases or 
syndromes among the reported cases of 
so-called agranulocytosis. It is likely that 
more careful study will separate them into 
secondary and primary groups, the second- 
ary being toxic in origin and the primary 
of leukemic nature. 

SYMPTOMATOLOGY. 

The onset is usually sudden while the 
patient is apparently well or is being 
treated for some chronic illness. It is 
usually ushered in with symptoms of a bad 
cold or a severe sore throat, or the angina 
may come later or not at all. High fever, 
prostration and symptoms of profound 
toxemia soon become manifest, at the onset, 
out of all proportion to the local lesion. 
The first complaint may be such (as in our 
case) that the throat may not be suspected, 
and indeed whether the throat infection is 
the result or the cause of the leukopenia is 
a debated question. In the majority of 
cases there soon appear ulcers and necroses 
of the tonsils and pharynx with or without 
involvement of the pillars, uvula, hard and 
soft palate, tongue and gums. These ulcera- 
tions are covered with a necrotic membrane 
which has an appearance suggesting diph- 
theria, and indeed a large number of 
reported cases had been given diphtheria 
antitoxin before the diagnosis was made. 
As the disease progresses the ulceronecro- 
tic condition spreads, causing extreme 
dysphagia, and, when it involves the 
alimentary tract, marked gastrointestinal 
symptoms — nausea, vomiting, diarrhea and 
abdominal pain. Anal ulcers result in 
severe pain, as noted in our case. A rather 
distinguishing characteristic of the lesions 
is the lack of an inflammatory reaction 
around them. The regional lymph nodes are 
tender but there may be very little, if any, 
enlargement of the glands. Jaundice occurs 


in about 50 per cent of cases. There is no 
tendency to hemorrhage. The liver and 
spleen may be normal in size or slightly 
enlarged. The toxic symptoms become 
rapidly worse and are followed by delirium 
and death. Among the recoveries which 
occasionally occur, recurrences are not in- 
frequent. The prognosis is usually fatal, 
especiafly in those cases which have a very 
acute onset and course and with extensive 
lesions. The disease as a rule runs a rapid 
course, though some cases have lived weeks 
and months. The recoveries in reported 
cases average about 12 or 15 per cent. 
In a series of fifteen cases reported by 
Rosenthal 8 he had 40 per cent recoveries. 

LABORATORY DATA. 

If the blood count is taken at the onset 
it may be normal. Very soon, however, 
there is noted a marked leukopenia. The 
total white counts in reported cases range 
from 5,000 to 100. The granulocytes are 
greatly diminished, and as the disease ad- 
vances they completely disappear from the 
picture. There is also a decrease in the 
lymphocytes. The plasma cells and mono- 
cytes may be increased. Macrophages and 
even myeloblasts may be found. The 
platelet count may be normal and there is 
very litt’e disturbance in the erythrocyte 
count and hemoglobin, although cases with 
some anemia have been reported. The 
bleeding and clotting time remain normal. 

Blood culture has been positive in only 
28 of the 75 cases in which blood cultures 
were made. For this reason and because 
of the various types of organisms recov- 
ered, agranulocytosis cannot be considered 
as an acute infectious disease. In favorable 
cases the blood picture rapidly becomes 
normal, the young polynuclears (stabker- 
nig) make their appearance as the leuko- 
cyte count begins to rise. 

DIAGNOSIS. 

Diagnosis usually presents little difficulty. 
The marked leukopenia with absence of or 
greatly diminished granulocytes occurring 
in a patient with symptoms of a profoundly 


36 


Strain-0’ Mara — Agranulo cytic Angina 


toxic angina is usually diagnostic. The dis- 
ease, however, must be differentiated from : 

(1) Pernicious anemia by the extreme 
prostration and the absence of the typical 
Addison-Biermer blood picture. 

(2) Aleukemic leukemia by the blood 
picture and the symptoms, and by the 
absence of the increasing enlargement of 
the lymph glands. This diagnosis is not 
always easy, however, and in some instances 
the pathologic examination of the bone 
marrow must be resorted to. 

(3) Aplastic anemia by the absence of 
interference with the formation of red 
blood cells, thrombocytes, and lack of ten- 
dency to hemorrhage. 

(4) Noma by the ulceration of the oral 
mucous membranes in this condition with- 
out the characteristic blood picture. 

(5) Monocytosis by an increase instead 
of a decrease in the total white count, and 
by the mild course of this disease. 

(6) Sepsis by the history, physical find- 
ings and the blood picture. 

(7) Diphtheria by absence of the Klebs- 
Loeffler Bacillus. 

It must be remembered, too, that sec- 
ondary agranulocytosis and ulcerative 
conditions may be terminal complications 
of Hodgkin’s disease, or the result of 
roentgen-ray or radium therapy, neosalvar- 
san or benzol poisoning. 

PATHOLOGY. 

Post mortem examination usually reveals 
extensive ulceration of the mucous mem- 
branes (tongue, tonsils, throat, larynx, 
pharynx, vagina, rectum and whole intes- 
tinal tract) . Microscopic examination re- 
veals an absence of the inflammatory zone 
commonly seen around ulcers. The liver, 


spleen and lymph glands may be slightly 
enlarged or normal microscopic examination 
of them showing nothing remarkable. The 
bone marrow is liquid and varies in color 
from straw to an intense red. There is 
almost complete absence of granular cells 
and there is a granulocytic aplasia. It con- 
tains many plasma cells and lymphocytes. 6 
Bone marrow removed from the sternum 
during the height of the disease 10 may 
reveal a similar picture. There is an in- 
crease in the reticulo-endothelial cells of 
the bone marrow, spleen and circulating 
blood. 9 

TREATMENT. 

Treatment for the most part is symptom- 
atic. Many forms of therapy have been 
tried but in the favorable cases recovery 
can not always be ascribed to the therapy, 
as spontaneous recovery is probable in most 
cases. 

Radiation of the long bones with stimu- 
lating doses of roentgen-rays seems to be 
of some value. Blood transfusion may be 
worth trying, but there is little evidence of 
much benefit from it. Fisher 11 reports a 
case with recovery treated with immuno- 
transfusion. Neo-salvarsan, iron, arsenic, 
liver, bone marrow, various nuclein ex- 
tracts, streptococcus serum, diphtheria an- 
titoxin, mercurochrome, typhoid vaccine 
intravenously, have all been tried with 
little or no success. Local applications to 
the lesions of silver nitrate, arsenic or other 
solutions seem of little value. 

The report of our case follows : 

CASE REPORT. 

Miss A. H., white, aged 56 years, was admitted 
to the Sanatorium June 17, 1930. Her father 
died at the age of 81 years of unknown cause, her 
mother was still living, aged 76 years, but was 
suffering from “bronchial trouble” and glaucoma. 
She had one brother, and three sisters living and 
well, one having recovered from pulmonary tuber- 


Strain-O’Mara — Agranulocytic Angina 


37 


culosis four years ago. She had been married 
twice, her first husband having died, cause not 
known, and the second divorced. She had never 
been pregnant. She gave the history of having 
had whooping cough and measles during childhood, 
typhoid at ten, influenza in 1915 and 1922, and 
malarial hematuria at twenty. She had had a 
cholecystotomy in 1911, a double oophorectomy at 
24 years, tonsillectomy in 1922. Her teeth had all 
been extracted in 1921. At the age of 24 years 
she had suppurating supraclavicular glands which 
discharged about one year. 

In November, 1929, she had an attack of acute 
pleurisy on the left side with severe pain and 
some fever for two weeks. Since then she had 
had soreness in her left chest, some cough and 
expectoration, with occasional elevation of tem- 
perature to 99.4 degress F. She had never ex- 
pectorated blood. She had some dyspnea on ex- 
ertion, tired very easily, was very nervous and 
slept poorly. Her appetite was poor and she 
was greatly annoyed by fullness after meals, 
regurgitation of food, and constipation. She had 
not menstruated since her operation at twenty- 
four, had no pelvic symptoms. 

On examination she was found to be of small 
frame, and slender, being 60 ^ in. (151 c.m.) in 
height, and weighing 91% pounds (41.7 kg.). Her 
blood pressure was 138/90. She wore well-fitting 
plates over edentulous gums. Considerable faucial 
tonsillar tissue remained, especially on the left. 
An old scar was noted on right side of neck over 
posterior cervical lymph chain. Cervical lymph 
glands were palpable, not tender. The chest was 
somewhat of emphysematous type, with rather 
marked thoracic kyphosis. There was increased 
tactile fremitus over both apices, and dullness on 
both sides to the second ribs and third dorsal 
vertebra. Rales were detected after cough above 
the third rib on both sides. Whispered voice 
sounds were increased over same area. There 
were scars on the abdomen from the cholecystot- 
omy and oophorectomy wounds. The spleen was 
not palpable. Stereo-roentgenograms revealed old 
chronic fibroid lesions both uppers with no cavi- 
tation. Urine was practically normal, Wasser- 
mann negative, feces negative, and blood smear 
was negative for malaria. Sputum was not exam- 


ined because she was unable to raise enough for 
a satisfactory specimen. On June 18, her blood 
count was as follows: erythrocytes 4,690,000, 
hemoglobin 85 percent; leukocytes 5,000, neutro- 
philes 51 per cent, eosinophiles 7 per cent, lympho- 
cytes 42 per cent. A diagnosis of chronic tuber- 
culosis of the lungs, moderately advanced, was 
made. 

She was admitted to the convalescent ward 
where she ran temperature ranging within normal 
limits, only occasionally going to 99° or a frac- 
tion above. Her pulse rate averaged 80. She 
was given bath room privileges and was allowed 
up and about the ward a little. She was thought 
to be doing well except for some nervousness un- 
til July 26, five weeks after admission, when she 
began to complain of rather severe pain in the 
rectum, and her temperature rose to 102.4 de- 
grees. Nothing was noted on examination to ac- 
count for the pain, but a beginning ischiorectal 
abscess was suspected. Codein, and application 
of local heat were employed with some relief. On 
the next day, the pain was much worse, and her 
temperature had risen to 104 degrees. Again 
rectal examination revealed no definite cause for 
her pain, there being no swelling. The anus ap- 
peared normal, but there was extreme tenderness 
in the perineum and digital examination elicited 
such great pain that it was evident proctoscopic 
examination could not be made without anesthesia. 
Opiates and local heat again gave relief. On 
the following day, July 28, the temperature 
reached 104.6 degrees F. The patient was ex- 
tremely restless, and semi-delirious. The rectal 
discomfort had subsided somewhat, but she com- 
plained of sore throat and some difficulty in swal- 
lowing. Examination of the throat revealed a red- 
dened pharynx, with a whittish membrane on the 
left tonsil and tenacious drying mucus on the pos- 
terior pharyngeal wall hanging down from the 
naso-pharynx. A smear from this revealed nu- 
merous gram positive cocci of a great variety but 
no Klebs-Loeffler nor Vincent’s organisms. A 
blood count made at the same time revealed only 
650 leucocytes per cubic milimeter. Of these 96 
per cent were lymphocytes and 4 per cent mon- 
onuclear leukocytes. No polymorphonuclear leu- 
kocytes were found after prolonged, careful 
search. A diagnosis of agranulocytosis was made, 


38 


Strain-O’Mara — Agranulocytic Angina 


and the family was informed of the gravity of her 
condition. 

On July 29 the temperature remained high, the 
patient was semi-delirious and was unable to take 
the proper amount of liquid. There was extreme 
tenderness on both sides along the neck but the 
glands were not noticeably enlarged. Examina- 
tion of her throat revealed numerous small pete- 
chiae on the soft palate. A definite ulcer had 
appeared on the left tonsil, about 5 c.m. in diam- 
eter, sharply outlined and not surrounded by an 
inflammatory zone. The base was covered with 
a grayish white exudate which could not be wiped 
off with a swab. Several small ulcers of similar 
character were noted on the oropharynx. The 
blood count on this day was 250 leukocytes, 98 
per cent lymphocytes and 2 per cent large mon- 
onuclears. Again no granulocytes could be found. 
The red blood cells numbered 4,340,000, hemoglo- 
bin 55 per cent. Liver and spleen were not en- 
larged. 

With a hope that production of leukocytes might 
be stimulated, a first degree erythema dose of 
ultra-violet rays was given. The next day, July 
30, the leukocyte count was 400 with 85 per cent 
small lymphocytes, 11 per cent large lymphocytes 
and 4 per cent large mononuclears. Her general 
condition was growing rapidly worse. July 31 
the blood count was 400, 100 per cent lympho- 
cytes. She was irrational, fever remained high, 
and she was much weaker. Attempt to swallow 
resulted in strangling and regurgitation through 
the nose. There was a blood streaked, dirty gray- 
ish, false membrane covering the whole pharynx 
and the left tonsil. The pulse became weak and 
thready. Coarse rales were heard throughout the 
chest, the temperature remained high (104°), un- 
til death occurred at 12:30 that night. At no time 
was there any jaundice or other skin manifesta- 
tion. Autopsy was not obtained, but immediately 
after death careful examination revealed several 
small ulcers just inside the anus near the mucocu- 
taneous border. The vagina and the rectum above 
this were normal. 

Treatment was symptomatic. Local application 
of silver nitrate solution to the throat lesions, and 
hot fomentations were used. Roentgen-ray ther- 
apy was not available. 


SUMMARY. 

(1) The cause of agranulocytosis is not 
known. Theories advanced are that it is : 

(a) A specific disease entity. 

(b) A result of some chemical 
poisoning or of some chronic 
disease or diseases. 

(c) Secondary to some endocrine 
influence. 

(d) A malignant leukopenia of 
leukemic nature. 

(2) The cardinal symptoms of the 

disease are : (a) Symptoms of profound 

sepsis with sudden onset; (b) necrotic 
u’cerations of the mucous membranes; 
(c) marked leukopenia with great reduc- 
tion or complete absence of granulocytes. 

(3) Careful blood studies make the 
diagnosis. 

(4) The course is rapid and usually 
fatal. 

(5) Pathologic study reveals granulo- 
cytic hypoplasia of the bone marrow and 
the absence of inflammatory zone around 
the local lesions. 

(6) Treatment is very unsatisfactory, 
roentgen radiation of the long bones seems 
to be of some value. 

(7) A typical case occurring in a 
woman suffering from fibroid tuberculosis 
is reported. 

BIBLIOGRAPHY. 

1. Schultz: Deutsche Med. Wochenschrift, 48:1496, 1922. 

2. Blumer: Amer. Jour. Med. Sci., 179:11, 1930. 

3. Ibid. 

4. Lovett: J. A. M. A., 83:1498, 1924. 

5. Friedamann : Med. Klinik, 19:357, 1923. 

6. Gordon: Ann. Int. Med., 3:1008, 1930. 

7. Potts: Arch. Otolaryngology, 9:257, 1929. 

8. Rosenthal: The Laryngoscope, 40:592, 1930. 

9. Arch. Otolaryngology, 11:810. 

10. Buck: J. A. M. A., 93:1468, 1929. 

11. Fischer: Jour. Mich. Med. Soc., 29:435, 1930. 


CASE REPORTS AND CLINICAL SUGGESTIONS 


A CLINICAL MEETING. 

The following series of case reports, with 
a presentation of the patient in certain in- 
stances or the pathologic material, were 
given by the consultant and regular staff 
of the U. S. Marine Hospital at New 
Orleans at the regular meeting of the 
Orleans Parish Medical Society, held Febru- 
ary 23, 1931, at the Marine Hospital. 

ADVANCED BANTI’S DISEASE- 
SPLENECTOMY; CURE. — Pre- 
sented by W. R. Metz, M. D. 

Miss A. B., aged 26 years, was admitted to this 
hospital on September 20, 1926, four and a half 
years ago. She was principally concerned about 
her eyes being “blood shot” and applied at the 
Eye, Ear, Nose and Throat Clinic for treatment. 
Sub-conjunctival hemorrhages were noted and 
patient was referred to the Department of Internal 
Medicine for a complete work-up. 

The condition of the eyes had been worrying her 
for only a few days, but she stated that for a 
rather indefinite period weakness and a poor appe- 
tite had been present. There were no other com- 
plaints. The family history and past history were 
inconsequential except for typhoid fever and 
malaria ten years previous to admission and a few 
years later a tonsillectomy. 

Physical examination showed a well developed 
patient with an obvious anemia. Height was 62 
inches and weight 118 pounds. 

Eyes showed small sub-conjunctival hemor- 
rhages. The heart was not enlarged, the rate was 
72 and rhythm was regular, but a systolic murmur 
was present at the apex and base. The blood 
pressure was 120/55. The abdomen was slightly 
distended and gave the physical findings of free 
fluid. The liver was moderately enlarged. The 
spleen was rather markedly enlarged. The skin 
was slightly ichteroid. 

The laboratory reported a negative Wassermann, 
negative sputum and negative stool. The urine 
contained no trace of albumen. Gastric analysis 
was negative, except for a free HC1 of 10 and 
total acidity of 32. Red blood cell count was 
2,500,000. Hemoglobin 38 per cent. White blood 
cell count was 4,800 with a normal differential 
count. 

On the basis of a secondary anemia, leukopenia, 
enlarged spleen and liver and ascites, a diagnosis 
of Banti’s Disease was made. 


The patient was started on the usual regime for 
anemia. On October 1, 10 days after admission, 
the patient fainted. A few hours later she vomited 
a large amount of fresh blood. The pulse became 
so weak that a blood transfusion was decided im- 
perative. A half-hour after transfusion, another 
copious gastric hemorrhage occurred and in 
another hour two more severe hemorrhages took 
place. The pulse was thready and could not be 
counted. The patient was supported with mor- 
phine and proctoclysis. The following day the 
fifth gastric hemorrage in 24 hours occurred. The 
red blood cell count at this time was 1,290,000. 

During the following ten days four transfusions 
were done and one abdominal paracentesis. 
2,400 cc. of clear straw-colored fluid was removed 
from the abdomen. 

With a red blood cell count of 1,840,000, the 
fifth transfusion was done and patient operated. 
Splenectomy was done and patient was again 
transfused. 

Two days following operation the red blood cell 
count was 2,325,000; one month later 2,730,000; 
two months later 3,310,000; three months later 
4,000,000; four months later 4,430,000. 

The post-operative convalescence was moderately 
stormy for the first few weeks. Abdominal para- 
centesis was necessary only after the operation 
and there has been no recurrence of abdominal 
fluid. At the end of three weeks she was up in a 
wheel-chair and at the end of the seventh post- 
operative week she was discharged. She returned 
at bi-weekly intervals for laboratory check-up dur- 
ing the following three months. At that time her 
blood picture was considered normal. 

Today, four and a half years after splenectomy 
for an advanced Banti’s Disease, she is symptom 
free and the blood picture is normal. She has been 
very kind to us in presenting herself for a follow- 
up and permitting us to present her case record 
at this meeting. 

TRAUMATIC ANEURYSM OF THE 
LEFT BRACHIAL ARTERY.— Pre- 
sented by W. F. Ossenfort, M. D. 

Traumatic aneurysm of a healthy artery usually 
follows a pentrating wound. The case to be pre- 
sented did not have a penetrating wound. All 
symptoms and signs followed almost immediately a 
trauma to the left arm. No reason has been found 
for not considering the artery healthy at the time 
of injury. 


40 


Case Reports and Clinical Suggestions 


T. W., aged 29 years, was about his usual work 
on January 23, 1931, when he slipped and fell back- 
ward, striking his left arm against a wall. He 
thought it only a minor injury, rubbed his arm a 
bit and went on working. After about ten minutes 
his left arm became numb, cold and weak. He 
stopped working. That night the pain in the arm 
was severe and he noticed for the first time a 
throbbing mass in the back of his arm near the 
arm-pit. Relief from pain was obtained by alter- 
nating lowering and raising the forearm. Two 
days later he entered the hospital. 

Examination on entrance showed the left arm 
and hand fairly cyanotic. The left hand was 
notably colder than the right. There was a pul- 
sating mass at the posterior lateral axillary fold 
about the size of a lime. It could not be accur- 
ately outlined. 

A definite bruit could be heard over the mass. 
Pulsation was absent below the mass. The patient 
complained of pain when the arm was elevated 
above the head. There was a moderate impairment 
of touch sensation, over the area supplied by the 
ulnar nerve. There was no motor disturbance. 
The remainder of the physical examination was 
negative. Laboratory was negative. Roentgen- 
ray shows an old fracture at elbow with two small 
loose fragments. 

The family history and past history added noth- 
ing. Four days after the injury there was still 
cyanosis of the nails of the left hand. On the fol- 
lowing day the nails were no longer cyanotic, but 
definitely pink. The patient had much less pain, 
slept well and stated that his arm felt much 
stronger. 

Eight days after injury, temperature readings 
were taken of both hands, using the method of 
inserting a thermometer bulb through a hole in a 
rubber glove worn by the subject. The tempera- 
ture of the left hand was almost exactly room 
temperature. It was 8.4° centigrade colder than 
the right hand. Simple calorimetric determin- 
ation showed less heat output by the left hand but 
this was not a satisfactory criterion since keeping 
the forearm in the calorimeter was too uncomfort- 
able after only twenty minutes. 

On the ninth day, temperature difference was 
5.5 C., and on the tenth day 4.1° C. The progress 
in temperature equalization was parallel with sub- 
jective progress. The arm was much stronger and 
gave practically no discomfort. 

From the twelfth to seventeenth day there was 
more pain and discomfort. On the seventeenth 
day the temperature difference was 10.4° C-, 

greater than it had been ten days previously. 
His sleep was interrupted with pain in the arm. 


Relief was obtained by lowering the hand over 
the side of the bed. 

At the end of three weeks, when condition was 
practically stationary, the patient was started on 
seances of applying digital pressure over the 
axillary artery above the aneurysm with a view to 
further increasing collateral circulation. After 
doing this for four days the axilla became tender 
and the hand more painful. The pressure seances 
were consequently discontinued. Examination at 
this time showed the mass about the same size 
but definitely less pulsatile. The bruit was more 
marked. Temperature was 32.1 or about 4 degrees 
subnormal. This was four weeks after the injury 
but there was no perceptible pulsation below the 
mass. 

This patient presents then a definite aneurysm, 
probably a false aneurysm pathologically, of the 
first portion of the brachial artery with occlusion 
of the brachial trunk. Collateral circulation has 
developed to an extent where tissue vitality is good 
and according to Dr. Matas this is the principal 
criterion of collateral circulation. 

Various devices have been reported for empirical 
testing of collateral circulation. Dr. Brooks and 
later Dr. Singleton injected sodium iodide jnto the 
arterial lumen and took skiagraphs. Brooks later 
developed a method of taking temperature of sub- 
cutaneous tissue of an extremity by the use of a 
thermocouple. This necessitated puncturing the 
skin for each temperature, reading. 

We have not resorted to sodium iodide injection 
because we feel that circulation is none too good 
at present and we know that sodium iodide has 
caused serious damage when so used. 

Treatment of the case has been expectant. 
Theoretically, at the end of four to six weeks, col- 
lateral circulation should be at its best, and at that 
time surgery will be attempted. The surgery most 
often used in these cases is the Matas operation of 
endoaneurysmorrhaphy though in some cases proxi- 
mal ligation is the operation of choice. Prognosis 
is excellent as a rule. 

The patient was examined again today. The 
mass no longer pulsates. It is quite firm. There 
are no complaints. 

BLASTOMYCOSIS OF KIDNEYS.— Pre- 
sented by Noka B. Hon, M. D. 

C. H., white male, merchant seaman, age 
27 years, a native of Louisiana, entered the 
Marine Hospital for the second time on Decem- 
ber 21, 1930, complaining of fever, a dull pain in 
the back and pus in the urine. These complaints 
were substantially the same as those made when 


Case Reports and Clinical Suggestions 


41 


he first entered the hospital five years ago, except 
that all symptoms are more severe. 

Present illness began about three months prior 
to his first admission into the hospital, as a con- 
stant dull aching pain in the lumbar region of 
the back. He noticed that his urine contained a 
thick white sediment most of the time. He had 
never had any urinary disturbances, void 3 to 4 
times daily, no nocturia. He noticed blood in the 
urine for the first time about two years ago. 
This hematuria was not severe, lasted for eight 
days and has never been present since. Attacks 
of fever have become more frequent in the last 
year and are present almost every afternoon. At 
times the temperature has reached 104° F., and 
remained so for two or three days at a time. 

Since his discharge from this hospital five years 
ago, he has been under constant medical care and 
has been in three other hospitals. In spite of this 
treatment, he says he is having more pain and 
fever than he has ever had before. He now com- 
plains of pain in his left chest but there is no 
cough nor hemoptysis. He has lost eight pounds in 
the last three months. Recently he has become 
very nervous and irritable and at times rather 
depressed about his condition. 

Physical examination reveals well developed and 
nourished white male of 27 years, 5 feet 9 inches 
tall, weighing 141 pounds. Abdomen: He com- 

plains of pain and tenderness to slight pressure 
along each costal margin and entire left portion 
of upper abdomen. There is considerable muscle 
tenseness over upper abdomn, especially over the 
left hypochondriac region. The kidneys nor spleen 
could not be felt because of tenderness and muscle 
guard. Back: Patient also complained of pain 

and soreness over each kidney region from slight 
pressure, more marked on the left. The physical 
examination otherwise was negative. 

Laboratory Findings : Daily urine examinations 

have been constantly negative with the exception 
of three plus pus in all specimens and some micro- 
scopic red blood cells following cystoscopy. Blood 
examination: W. B. C. 9600. Neutrophiles, 72 per 
cent; small mono. 22 per cent, large mono. 6 per 
cent; malaria negative. Sputum: Negative for 

acid fast organism or fungus. Wassermann and 
Kahn, negative. P. iS. P., 1st hour 42 per cent, 
2nd hour, 8 per cent; appearance 2% minutes. 
N. P. N. 30 mg. per one hundred c. c. of blood. 

Roentgen-ray Reports: Chest, no suggestion of 
blastomycosis. Probable bronchiectasis of the 
lower portions of both lungs. Adhesions to the 
diaphragm, flat plate of G. U. tract negative. 
Pyleograms, negative. 


Cystoscopic Examination: Urethra and pros- 

tate are normal. Bladder, no residual, capacity 
400 c. c. mucosa presented a diffuse dark red color 
over the trigone and at vesical orifice. The left 
ureteral orifice was swollen ad projected into the 
bladder for about 0.5 cm. Ureteral catheters 
passed easily on each side withotu apparent 
trauma. Normal waves of cloudy urine returned 
from each side. 

The kidney urine has been cultured several 
times. In 1925 during his first hospitalization, 
six positive cultures were obtained and reported 
as fungus (blastomyces type). During this ad- 
mission cultures of all specimens from the kidneys 
have been negative. Cultures from the bladder 
were reported fungus blastomyces type. Smears 
from kidney urine were reported 3 plus and “Few 
blasting fungus in each specimen.” 

Treatment has consisted principally of intrav- 
enous infusions of 10 c. c. of 10 per cent sodium 
iodide four to six times weekly. Potassium iodide 
in mouth 15 gr. T. I. D. He has had 38 cysto- 
scopic treatments in the last five years, consisting 
of lavage of kidney pelvis and ureter with 1 per 
cent silver nitrate alternating with 1 per cent 
mercurochrome. He has also received 10 grams 
of urotropin and 30 grams of sodium acid phos- 
phate three times a day. The surgical consultant 
examined the patient and advised aspiration to see 
if there was a renal or peri-renal abscess present 
but no pus nor fluid could be obtained. 

Progress: The patient has shown some im- 

provement. He has very little pain at present and 
the tenderness and soreness of his back has greatly 
decreased. His temperature has been normal for 
the past three weeks. He has gained about 
10 pounds since admission. His urine continues 
to have three plus pus but no recent attempts have 
been made to culture it. 

LEONTIASIS OSSEA.— Presented by T. B. 

McKneely, M. D. 

Briefly, leontiasis ossea may be defined 
as a “localized or diffuse hyperostosis of 
any or all the bones of the cranium and 
face.” The most common age of onset is 
between ten and fifteen years, although it 
may be congenital. The condition begins 
most frequently in the bone where it 
may remain isolated or spead to others. 
Symptoms from nerve pressure and space 
encroaching processes may or may not be 
present. This patient presents so definite 
a hyperostosis of the bones of the cranium 
and face that I feel this may be considered 


42 


Case Reports and Clinical Suggestions 


an example of this clinical condition. The 
patient’s age, the age of onset, the relatively 
normal condition of the other bones of the 
body, together with the skull and facial 
changes certainly label this leontaisis ossea. 
Therefore, I present the following case : 

L. R., a negro male, aged 18 years, employed 
on a ferry boat, entered this hospital on Octo- 
ber 24, 1930, with a chief complaint of a penile 
ulcer. This complaint is of no particular interest 
to us now. The striking feature of this boy was 
the enormous enlargement of the bones of his head 
and face. 

Present Illness: The history, as obtained from 

the patient was rather vague. The onset must 
have been in early childhood. As far back as he 
can recall, his head has always been larger than 
the heads of others, but when he started to grow, 
apparently about the age of puberty, his head 
out-grew the rest of his body. This growth was 
never associated with pain of any sort. He has 
not noticed any enlargement in the past two or 
three years. 

A review of the systems revealed little other 
than negative findings. A detailed neurological 
survey has not been done. However, the patient 
gave no history of headaches, vertigo, vomiting, 
deafness, or attacks of blindness. He was men- 
tally alert and his intelligence equalled the aver- 
age for a negro boy of his age. His outlook on 
life was characteristic of his race. The penile 
lesion had been present two weeks, when he en- 
tered the hospital. The presence of this ulceration 
bore mute testimony to his libido. 

Past history: The patient had a healthy child- 
hood and did not recall any serious illnesses. He 
been knock-kneed since early life. At the age of 
12 years, he fell down a hill, injurying his left 
knee. It was immobilized for a short time, and 
as soon as the dressing was removed, the patient 
began to walk about. This increased the deformity 
to a very marked genu valgum. 

Family history: The parents were both normal 

in development; the father quite a robust man. 
The patient was the sixth child of seven. All the 
brothers and sisters are in good health. None of 
them present any such cranial development as 
found in this boy. 

Physical examination: The general appearance 

is that of a young negro male, not acutely ill, 
possessing a noticeably large head, and a marked 
deformity of the lower extremities. His gait is 
altered but he manages to walk with little difficulty. 
He is 60% inches tall and weighs 115 pounds. 
His blood pressure is 120/78; pulse 88 per minute. 


The skull is the main point of interest. The 
anterior-posterior diameter appears lengthened in 
comparison to the lateral. The occipital region 
is markedly protuberant, apparently from an 
overgrowth of the occipital bone. The frontal 
region is not especially prominent. Palpation re- 
veals that there is a depression along the line of 
the frontal, saggital, and lambdoid sutures, quite 
marked in the region of the anterior and posterior 
frontanells. All the facial bones have participated 
in this general, symmetrical hyperostosis. The 
superior maxillae are heavy and the alveolar pro- 
cesses are thickened and lengthened, so that 
the teeth are spaced farther apart, giving an 
impression of peg-teeth. The mandible is also 
hypertrophied. Due to its overgrowth, there is a 
decrease in the space between the chin and chest. 
The face as a whole appears not unlike that of 
one of the higher anthropoids. The fronto- 
occipital diameter of the skull is 67 cm.; the 
sub-occipito-bregmatic, 63 cm. 

The eyes show no evidence of proptosis. The 
pupils are equal, regular, reacting to light and 
accommodation in a normal manner. The eye- 
grounds are normal and vision is not impaired. 
The ears are quite small, with an adherent lobule 
and an almost complete absence of the helix. His 
hearing is normal. 

The neck is rather short, especially in front; 
there are no masses to be felt in the thyroid and 
parathyroid region. 

The thoracic cage is rather small and of the 
barrel type. It is symmetrically developed. The 
clavicles are very heavy, especially the medial 
extremities, and appear shorter than normal, as 
if some of the length were taken up in an in- 
creased curvature. The ribs present definite 
evidence of beading. 

The genitalia are normally developed, except for 
some slight scarcity of pubic hair. There is a 
slight scar on the inner surface of the dorsal 
prepuce. 

The extremities show some departure from 
normal. The humerus is shorter than it should 
be. The hands are thin and the fingers are long 
and tapering, typical “artistic hands.” There is 
a moderate genu valgum of the right leg with a 
marked inward and slightly forward displacement 
of the left knee. The tibiae show no evidence of 
forward bowing. The tissue over the bones is 
smooth with no suggestion of any osteo-periostitis. 

Laboratory Data: Blood picture, normal. No 

evidence of sickle-cell formation. 


Case Reports and Clinical Suggestions 


43 


Blood Chemistry: 

Total N. P. N 27.8 mg. per 100 cc. 

Calcium 8.5 “ “ “ “ 

Phosphorous 2.85 “ “ “ “ 

Sugar 84.0 “ “ “ “ 

Blood Wasserman, negative. 

Spinal fluid, urine, feces, sputum negative. 
Summary of Roentgenograms: Skull: The 

striking feature is the enormous thickening of the 
calvarium, which is uniformly increased through- 
out, measuring in the plate from 2.5 to 3 cms. 
There is no differentiation into an inner and an 
outer table. The density of the bone is so great 
that it is difficult to obtain clear pictures. Scat- 
tered over the frontal and parietal regions are 
small circular areas of decreased density, possibly 
due to cystic changes in the bone. The sella is 
apparently unchanged. The region of the sutures 
shows some separation. The frontal air cells are 
present but are proportionately increased in depth. 
There is hypertrophy of the bones of the face, in- 
cluding the upper and lower jaws. 

Teeth: Essentially negative. 

Long Bones: The humeri show marked disturb- 

ance in the upper ends with some tendency to 
cystic changes. There is an increased density of 
the shaft with a prominent deltoid tubercle. The 
tibiae show some tendency to bowing. This is 
slight, however. There is definite trophic dis- 
turbance of the outer end of the clavicles. 

Joints: The centers of ossification about the 

joints as studied in the plates of the hand, wrist, 
elbow and ankle, are within normal limits. The 
left knee shows possible evidence of an old injury 
but the changes are probably the results of 
trophic distrbances. 

Spine: The spine is essentially normal. There 

is no evidence of syphilitic changes in any of the 
bones. 

REPORT OF A CASE OF KERATOSIS 
FOLLICULARIS OR DARIER’S DIS- 
EASE. — Presented by Wiliam S. 
Dosher, M. D. 

In 1889 Darier in France and White in 
America, independently described this dis- 
ease. At the present time there has been 
a little more than one hundred of these 
cases reported in the various parts of the 
world. 

Little is known of the etiology of this 
disease. In the majority of cases the 


disease begins during childhood and it 
seems to have a predilection for males. 
There is some evidence to show that it may 
be heredity, though no such history was 
obtained in this case. No organism has 
been shown to produce the disease and it 
is not considered contagious. 

As originally described by Bowen, the 
lesions are caused by hyperkeratosis, effect- 
ing chiefly the sebaceous and hair follicles. 
The process is chiefly confined to the neck 
of the follicle but in the later stages it ex- 
tends into the interfollcular tissues. About 
the borders of the lesions there is an 
abundant pigment deposit in both the 
epidermis and corium. The only other 
change noted in the corium is a small 
amount of cellular infiltration. In the 
tumorous-like masses and vegetating lesions 
marked proliferation of the reti into the 
corium occurs, this process being second- 
ary to keratosis. The disease therefore is 
primarily and essentially one of the 
epidermis. 

There is no specific treatment for the 
disease. Various drugs such as sulphur, 
salicylic acid, ichthyol and resorcin have 
been used in the form of ointments and 
are used on’y as paliative remedies. Many 
observers are, however, of the opinion 
that radiotherapy is the remedy of choice. 

The prognosis as to the recovery from 
the disease is unfavorable but as to a 
serious termination of the disease is 
usually good. One case, however, has been 
reported as terminating in epithelioma. 

Sam Jones, colored male, aged 32 years, native 
of Louisiana, was admitted to this hospital on 
February 7, 1930, with chief complaint of 

sores on each buttock. 

The past history is interesting in that he had 
the usual childhood diseases, malaria at 20 years 
of age, gonorrhea at 17 and 32 years, syphilis at 
28 years, for which he has been treated. 

The history of the present disease dates back 
to his childhood. When about 13 years old, he 
noticed the rough appearance of the skin over his 
chest and face. Thirteen years ago small granu- 
lomatous masses with ulcerations appeared on each 


44 


Case Reports and Clinical Suggestions 


buttock. These ulcerationsn were not disabling 
enough to keep him from being drafted into the 
Army. While in the Army he was given five doses 
of salvarsan which seemed to exert a favorable 
influence upon the ulcerations but did not heal 
them. 

For the past ten years the masses and ulcera- 
tions on each buttock have been slowly increasing 
in size. He states the lesions were painful and 
annoy him greatly when he sits down as well as 
when the moon changes. 

In 1928 the ulcerating masses were cauterized 
with the actual cautery. Since that date he had 
no treatment except home remedies prior to com- 
ing to the hospital. 

The physical examination upon entering the 
hospital was essentially negative except for the 
skin findings. Over the scalp, face, axilla, trunk, 
perineum and legs there were large, rough, warty- 
like areas of epidermis. There was evidence of 
hyperkeratinization in these involved areas. On 
the hard palate there was also a roughened area, 
bluish in color, which is also a part of this picture 
of Darier’s disease. On each buttock there was 
a large granulomatous mass of mulberry topo- 
graphy which was tender and bled very easily. 
On the basis of these findings, the diagnosis of 
keratosis follicularis was made. The routine 
laboratory data is unimportant. 

A resume of the treatment and progress of the 
case is as follows: He has been given Donovan’s 

solution, minus II daily since his admission. A 
biopsy of a piece of tissue taken from the back 
of the leg was done and the pathologist reported 
“A slight area of degeneration on the surface, the 
underlying cells proliferating and showing early 
malignant changes.” Following this report the 
masses on each buttock were cauterized with the 
actual cautery. This cauterization seemed in- 
adequate and on April 4, 1930, he was given 
radium into the masses. The lesions seemed to 
improve and six weeks later radium was given 
again. Following this last radium treatment a 
large slough developed in the mass in the right 
buttock which slowly healed. On January 3, 1931, 
a slough developed in the left buttock which is 
healing slowly at the present time. He has also 
been given mercury, bismouth and mixed treat- 
ment. It is interesting to note that the general 
health of this patient has been good. 


TWO CASES OF PULMONARY TU- 
BERCULOSIS TREATED BY ARTI- 
FICIAL PNEUMOTHORAX. — Pre- 
sented by G. H. Faget, M. D. 

Artificial pneumothorax is the greatest 
advance that has ever been made as the 
treatment of pulmonary tuberculosis. By 
it, many otherwise hopeless cases are saved 
or have their lives prolonged. Since its 
general adoption about 25 years ago, its 
popularity has steadily increased so that 
at present it is used in as high as 20 per 
cent of the patients in some sanatoria. 

Each patient for this operation should 
be individually and carefully selected. 
There shouM be no hesitation in extensive 
unilateral cases. In those with bilateral 
involvement, the lesions in the better lung 
should be small in extent, not very active 
and preferably situated in the apex. As a 
means of checking uncontrollable hemop- 
tysis, it will often prove a life-saver. 

The technic can be found in any text- 
book on the subject. I would like to draw 
special attention, however, to a few im- 
portant points which are often overlooked 
and which adds to the simplifying as well 
as the safety of the operation. 

First, the simplest way of making the 
primary pleural puncture is with an ordi- 
nary 19 gauge hypodermic needle, the point 
of which has been filed to a short blunt 
bevel. The thorax is punctured with this 
needle while attached to a glass syringe 
partly filled with the anesthetic solution. 
As soon as the point enters the pleural 
space, the fluid level in the syringe will be 
noticed to slowly drop due to suction from 
the negative intrapleural pressure. This 
is the surest way of knowing just when 
the pleural space has been reached. 

'Second, never start the primary pneu- 
mothorax inflation until the manometer 
registers a good negative pressure with 
free respiratory ossilations. The usual 
pleural pressure will be found to vary 
between -4 and -10 mm. of water. A nega- 


Case Reports and Clinical Suggestions 


45 


tive pressure of less than -3 during full 
inspiration is a contraindication to turning 
on the air. 

Third, for an initial pneumothorax in- 
jection, the water in the two bottles of the 
pneumothorax apparatus should be on a 
level. Under these circumstances (i. e., at- 
mospheric pressure) the induction of the 
pneumothorax depends upon the negative 
pleural pressure drawing the air into the 
pleura from the proximal bottle. This pre- 
caution practically eliminates the danger of 
air embolism. With later refills, a positive 
pressure can be used by elevating the distal 
bottle without danger, since the two pleural 
layers have already been separated by a 
previous pneumothorax. 

Fourth, small inflations (about 400 c. c.) 
at frequent intervals are better than larger 
ones at longer intervals. The advantages 
of the small refills are first, a more gradual 
change in the intrathoracic viscera to 
which the patient can more easily adjust 
himse’f, second, the stretching of adhe- 
sions rather than their tearing which is 
dangerous, and third, the smaller fluctua- 
tions in pleural pressure which are thought 
will lessen the tendency to pleural effusions. 

Fifth, the use of the fluoroscope at 
frequent intervals is of great importance. 
The things to be noticed by fluoroscopy 
are: any shifting of the mediastium; the 
kinds of adhesions, the degree of cohapse 
of cavities, the formation of pleural effu- 
sion, and the condition of the opposite 
lung. 

Case 1. H. K., merchant seaman, 27 years old, 
first came under my care upon admission to the 
Marine Hospital at Fort Stanton, New Mexico, 
on July 12, 1929. 

Present history: Patient states that he first 

noticed that he was always feeling tired in 
January, 1929. At that time he had a productive 
cough, no appetite and was losing weight. There 
was a little fever and a few night sweats. The 
ship’s doctor examined him and told him he had 
tuberculosis. On February 21, 1929, he entered 
the Marine Hospital at Baltimore where his 
sputum was positive and at which time he had 
lost 16 pounds in weight. Roentgen-ray showed 


extensive infiltration left above 3rd rib with 
cavity. Right slight infiltration apex. 

The sputum was consistently positive and there 
was afternoon rise of temperature and rapid pulse 
while patient was confined to bed. It was con- 
sidered that his disease was very active and that 
artificial pneumothorax was indicated without 
delay. The patient consented to the operation 
and the first inflation was given 8 days after 
admission. 

Aside from a small pleural effusion during the 
early months, there was no postoperative com- 
plications. For the first two months there was 
a febrile reaction. The sputum remained posi- 
tive about four months. He was treated as a 
bed patient for the first six months. The cavity 
proved very resistant to collapse on account of 
adhesions and was only completedly closed after 
nine months and after the pleural pressure had 
gradually been raised to 2 or 3 plus. 

After 8 months of pneumothorax therapy, the 
patient was put on a course of supervised exer- 
cises with pulse and temperature checks. There 
were no untoward effects and shortly afterwards 
the patient started to work in a cleaning and 
pressing business. Without any ill effects he 
followed this occupation during the last nine 
months of his stay at Fort Stanton. 

On February 16, 1931, he was admitted to this 
hospital for a short period of observation and to 
continue the pneumothorax inflations which he 
was receiving every two weeks. Examination 
showed complete collapse of left lung by pneu- 
mothorax and no signs of activity in right lung. 
The patient is in good health, feels as well as he 
ever did and is back to his normal weight with 
a negative sputum. He realizes that he has about 
IV 2 to 2 years of pneumothorax ahead of him but 
knowing what his condition was before undertak- 
ing treatment, he is convinced that it is a life- 
saver for him and will continue it willingly. 

Case 2. R. V., merchant seaman, aged 24 years, 
was admitted to this hospital on September 23, 
1930, complaining of “fever” of three weeks 
duration. Accompanying the fever there was 
cough and slight expectoration. He also com- 
plained of night sweats and pain in left lower 
chest. The physical findings in the chest were 
impaired resonance over upper part of left lung 
with broncho vesicular breathing and increased 
whispered voice and medium rales in same area. 
The roentgenologist reported extensive involve- 
ment of left lung with cavitation at apex. Labor- 
atory report showed positive sputum (besides 3 
plus Wassermann and hookworm ova). 


46 


Case Reports and Clinical Suggestions 


Clinically, there was a febrile course, with 
variation between 36° C. and 39.8° C. during the 
first week. With bed rest this gradually declined 
to a maximum of 38° C. during two months of 
observation. His cough remained productive and 
his sputum positive. Under these conditions pneu- 
mothorax was decided upon November 20, 1930. 
Since then 20 inflations have been given. 

There has been a marked improvement. Expec- 
toration is at present very scanty and sputum 
negative. Temperature subsided to normal in six 
weeks and remained normal for three weeks. 
Following a small effusion there was an elevation 
with peaks of 0.2 to 0.8 daily for a few weeks 
but it is normal again since February 4th and 
there has been no spread to the good lung. The 
prognosis seems favorable. 

THE TREATMENT OF ENTAMEBIC 
DYSENTERY BY DUODENAL IN- 
JECTION OF IPECAC.— Presented 
by W. E. Anderson, M. D. 

No attempt shall be made in this brief 
discussion to review the literature on the 
treatment of entamebic dysentery but we 
will consider rather briefly the pathology 
and clinical symptoms before outlining the 
treatment and the results obtained in 
handling six uncomplicated cases here 
recently. 

Pathology: Any part of the large in- 

testine may be involved and a very early 
lesions consists of small raised hemor- 
rhagic areas which later lose their surface 
epithelium. The destructive lesions of the 
intestine consist of small erosions which 
may involve the mucosa alone, of ulcers 
with a crater-like appearance with un- 
dermined margins and finally of large 
irregular shaped ulcers whose bases are 
formed of muscular coat or even peri- 
toneum. These large ulcers are often 
formed by the coalescing of smaller 
neighboring ulcers through sinus com- 
munications formed in the submucosa, 
the overlying muscularis and submucosa, 
there sloughing off. The most typical 
amebic ulcer is the flask shaped one due 
to spreading out of the amebas in the 
submucous coat, the edges being formed 
of the overlying basement and mucous 
membranes. The accumulations of amebas 


in the submucosa tissues are attended by 
a low grade inflammatory reaction with 
edema, lymphocytic infiltration and fixed 
tissue proliferation. The amebas are par- 
ticularly found in the edematous tissues 
beyond the areas of most acute inflamma- 
tion in which intestinal bacteria also play 
a part. In some cases the tissues seem 
little able to resist infection and large 
gangrenous ulcers result, the walls of 
which, are soft and the bases of which are 
formed of blackish or greenish sloughing 
tissue in which numerous cocci bacilli and 
sometimes amebas are found. It is the 
opinion of some writers that these changes 
are not produced entirely by the amebas 
but are probably chiefly due to the bac- 
teria. Another process sometimes observed 
in the intestine in amebic dysentery is a 
diphtheretic one which is also probably 
caused by the bacteria present in the 
intestine. We will not discuss the path- 
ology of the complications which include 
abscess of the liver, lungs, brain and 
peritonitis. 

Symptoms: Cases of entamebic dysen- 

tery differ greatly in character and 
severity but for convenience of discussing 
the clinical course of the disease, the 
case may be grouped under (1) mild or 
latent forms; (2) those with acute onset; 
and (3) advanced or chronic forms. 
Cases with grave intestinal lesions may 
sometimes come to autopsy in which the 
individuals had during lift no intestinal 
symptoms sufficiently prominent to attract 
attention. While individual cases may 
vary widely, there are nevertheless some 
features which are common in at least the 
majority. These are the irregular course 
marked by periods of intermission and 
exacerbation ; abdominal symptoms ; the 
appearance of mucus in the stools, and the 
tendency to chronicity. A phenomena 
peculiar to the malady is the occurrence 
of amebic liver abscess. 

Treatment: Among the many remedies 

which have been used in the treatment of 
this Serious disease, the following may be 


Case Reports and Clinical Suggestions 


47 


mentioned: ipecac and its derivatives, the 
arsenicals, chapparo amargoso, quinine, 
oil of chenopodium, salicylic acid, anayodin 
and yatren. 

The partial failure of all emetine 
methods satisfactorily to cure amebic 
dysentery is probably explained by the 
fact that the active harmful parasites are 
located at the base and undermined edges 
of ulcers which are plugged up with a 
thick, tenacious substance consisting of 
mucus, blood, degenerated mucosa and 
dead and dying amebae and their secre- 
tions. Ordinary enemas do not clean out 
these plugs but active saline catharsis does 
remove much of the debris. The ideal 
treatment would seem to consist, therefore, 
in thoroughly cleaning out the ulcer craters 
by means of saline catharsis and then the 
rapid diffusion of the destructive agents 
through the whole bowel so that every 
ulcer will be treated. Not long ago Ander- 
son described the transduodenal method 
employed by him for the past seven years, 
which is as follows: 

(1) The patient is put on a nutritious 
lacto-farniaceous diet, with frequent feed- 
ings. (2) In the morning after a twelve 
hour fast, a regulation duodenal tube is 
passed well into the patient’s duodenum, 
its location being determined by the usual 
methods, preferably by roentgen-ray. The 
tube may have to be passed the night 
before where much pylorospasm exists. 
(3) The pylorus is encouraged to close by 
giving the patient 4 or 5 ounces of cold 
milk to drink alongside the tube. (4) A 
Jutte transduodenal lavage is performed — 
500 c. c. of a 10 per cent aquaeous solution 
of sodium and magnesium sulphate is 
allowed to run slowly through the tube 
into the duodenum. This usually produces 
a copious, watery evacuation in from 


20 to 30 minutes, and can be shown to 
clean out the ulcer bases very satisfactorily. 
(5) Twenty minutes after administration 
of the hypertonic salt solution, there is 
poured down the tube a suspension of 
1 dram of powdered ipecac in 100-200 c. c. 
warm water and this is followed by 50 c. c. 
more of water to wash out the tube. The 
tube is left in situ for a few minutes as in 
its removal a little ipecac might be carried 
into the stomach and occasion very per- 
sistent vomiting. (6) An hour or so fol- 
lowing this treatment the patient resumes 
his feedings. (7) These treatments are 
repeated daily for seven days and are fol- 
lowed by an interval of seven days, and 
then another seven days course of treat- 
ment. This technic was carried out in 
our method of treatment except that we 
did not inject the ipecac daily, never 
oftener than every other day. 

A. B., a foreign seaman, 32 years of age, 
entered the hospital with the chief complaint of 
general weakness and an intermittent diarrhea of 
3 years’ duration. When the patient entered the 
hospital he was markedly dehydrated and exsan- 
guinated for he had been having 12-15 bloody 
bowel movements daily for 20 days prior to 
admission. Red blood count revealed 1,750,000 
with 30 per cent hemoglobin. Stool examination 
revealed ameba in large numbers. The handling 
of this case was first to treat his anemia and 
second to treat the dysentery. The patient was 
given a direct transfusion and saline subcuta- 
neously. He was given seven treatments as out- 
lined above at intervals of two days and within 
24 hours following the first treatment, he ap- 
peared very much improved and bowel movements 
were decreased to once or twice daily. After 
two treatments the stools were negative for 
ameba and cysts. 

W. B., aged 36 years, entered the hospital with 
the chief complaint of an intermittent diarrhea 
for 6 to 7 years. He had been having 10 to 12 
bloody, mucus stools daily prior to admission. 
Physical examination was essentially negative. 
iStool examination was positive for ameba. This 
patient was given six such treatments with 


48 


Case Reports and Clinical Suggestions 


marked improvement and stool was negative after 
first treatment. 

L. W., aged 38 years, entered the hospital with 
the complaint of a severe diarrhea which had an 
acute onset four days prior to admission with 
cramping pains in lower abdomen and a chill. 
Physical examination revealed tenderness over the 
entire abdomen and stool examination revealed 
motile ameba. The patient was likewise given 
six treatments at two and three days intervals 
with much improvement, a reduction in the 
number of stools after the first treatment, and 
absence of ameba and cysts. 

C. M., aged 65 years, entered the hospital with 
the chief complaint of a diarrhea, 8-10 stools daily. 
The first attack of dysentery dates back to 1899 
and since that time he has had five similar attacks. 
The present attack was of one month’s duration 
and was associated with nausea and vomiting. 
Physical examination was essentially negative but 
stool examination revealed ameba. He was given 
four treatments with ipecac with much symptom- 
atic improvement following each injection but 
stool examination and culture continued to reveal 
ameba. This patient was given Chapparo amar- 
gasa orally in conjunction with two other ipecac 
treatments and then the stools became negative. 

W. J. L., a lighthouse keeper, aged 38 years, 
entered the hospital with the complaint of diar- 
rhea, 3-4 stools daily. The present attack was of 
5-6 months duration. Past history revealed that 
patient was treated here seven years ago for a 
similar attack. Physical examination was essen- 
tially negative except for proctoscopic examination 
which revealed a stricture of rectum about 8 cms. 
from the anus. Stool examination was positive 
for ameba. After the first treatment patient felt 
much improved, bowels moved normally, and stools 
were consistently negative. Stricture of rectum 
was treated by dilatation with bougies upon two 
occasions and patient was allowed to return to 
liis family physician for further treatment. 

H. W. F., aged 33 years, entered the hospital 
with a complaint of a bloody, mucus diarrhea of 
1 year’s duration. The only positive findings 
were ameba in the stools. After the first treat- 
ment, the patient felt much improved and he was 
.given two other treatments. Following these he 


requested to leave the hospital and it was granted. 
Three weeks later he returned to the hospital 
with the complaint of diarrhea and cramps in the 
stomach. Stool examination failed to reveal the 
presence of ameba but smear made at the time 
of prostoscopic examination revealed them. He 
is under treatment here at the present time for 
this condition. 

SUMMARY. 

Our results obtained by this method of 
treatment have been very striking, for in all 
cases symptomatic improvement was noted 
24 hours following the first treatment and 
in most cases the stools remained negative 
for both ameba and cysts. We have not 
been able to follow these cases as we would 
like to but we have had only one return 
as yet and this patient had to leave after 
having only three treatments. This type 
of treatment appears to be very logical to 
me and I think it is worthy of further 
investigation and trial. 

ABSTRACTS OF THREE INTEREST- 
ING AUTOPSY CASES. — Presented 
by W. C. Dreessen, M. D. 

Primary Carcinoma of the Liver. — C. W. M., 
a white male, aged 65 years, entered the Marine 
Hospital on August 25, 1930, with a history 
suggestive of pyloric obstruction. He had had 
gastric distress since March, 1930, and vomiting 
since July 21, 1930, and had lost 62 pounds in 
the six months prior to admission. 

On physical examination the abdomen showed 
occasional peristalic waves. The mass was noted 
in the upper right quadrant about the size of a 
grapefruit, rounded in appearance and was dull 
on percussion. This dullness was continuous with 
that of the liver. Lateral to the mass, the liver 
was enlarged 3 to 4 fingersbreadth below the 
costal margin. The mass was firm, smooth and 
moved with respiration and felt more like a tense 
cyst than a fibrous growth, yet a fluid wave was 
not demonstrable. The mass appeared fixed to 
the liver and did not vary with changes in posi- 
tion. There was no tenderness. As a matter of 


Case Reports and Clinical Suggestions 


49 


fact, the patient had not been aware of the growth 
until his attention had been called to it by the 
interne making the original examination. 

Roentgenogram showed a definite filling defect 
of the pylorus. Enormous enlargement of the 
liver was present, interpreted as probably pri- 
mary carcinoma of the liver with involvement of 
the pylorus. Fluoroscopy showed no obstructing 
gastric lesion. 

Laparotomy on September 5, 1930, revealed 
inoperable carcinoma of the liver which was con- 
sidered by the surgical staff as probably secondary 
to gastric malignancy. Patient was returned to 
ward in poor condition and died a few hours later. 

At autopsy the liver was found to be enor- 
mously enlarged, weighing 4150 grams. It was 
relatively fim and the anterior surface pre- 
sented a few neoplastic nodules which were firm, 
yellowish brown in color. Attached to the right 
lobe of the liver by broad base was a tumor mass 
which was felt on the physical examination. This 
mass was rough and irregular on its outer surface 
and on sectioning it offered only slight resistance 
to the knife. Its mottled cut surface showed areas 
of pinkish grey cellular tissue separated by 
strands of connective tissue and dirty greyish 
areas with hemorrhagic zones. The mass was 
friable and while hemorrhage was abundant, it 
was difficult to demonstrate blood vessels. Near 
its attachment to the liver the tumor had destroyed 
liver substance except for a narrow rim. The 
structure was that of a primary neoplasm of the 
] liver. 

Tuberculoma of the Pons with Miliary Tuber- 
I culosis. — J. S., merchant seaman, white male, aged 
44 yearsi, was admitted to this hospital on Octo- 
ber 14, 1930, with diagnosis of acute adentitis of 
left cervical gland and right facial paralysis. 

He had had tuberculous glands removed from 
j the right side of neck at 12 years 1 . The right facial 
j paralysis was the result of an operation for a 
j tumor in the region of the lobe of the right ear. 

I The gland on the left side of the neck had pro- 
) gressively increased in size over a period of 
j 70 days. (It will be of no interest in this dis- 
I cussion since at postmortem it was found to be a 
•cyst of submaxillary gland.) There had been no 


subjective symptoms. He had had a pulmonary 
hemorrhage April, 1930. 

Chest findings on October 15 pointed to in- 
filtration of the lungs by a pneumonic process 
from 5th dorsal spine and 4th rib up on the right 
side and from 4th dorsal spine and 2nd rib up 
on the left side. 

The right knee jerk was somewhat exaggerated. 
Roentgenogram of the chest was reported as 
follows on October 18, 1930: “Extensive pulmon- 

ary tuberculosis of both lungs miliary in type 
with small cavity on left apex.” Sputum was 
positive for tubercle bacilli on November 8, 1930. 
November 13 patient complained of numbness of 
the right side of his face, right arm and leg. 
Marked weakness of the right leg was noted with 
flexion of the foot. Weakness of the right grip 
was also noted. No apparent reflex changes, how- 
ever, were noted at that time. 

On November 22 he complained of occipital 
headaches. November 26 the pulse was extremely 
rapid and respiration were labored. His throat 
filled with secretions and interfered with respira- 
tion. Throat reflexes were apparently reduced. 
He was stuporous but meningeal signs of irrita- 
tion were negative. iStupor progressively in- 
creased and toward the end there was marked 
drolling from the mouth and patient died Decem- 
ber 1, 1930. 

At autopsy the brain was generally congested 
on its outer surface but free from exudate. The 
base showed a globular mass occupying the entire 
left side of the pons and extending into right. 
On section it was found to measure 2.5 cm. in 
diameter and was suggestive in appearance to 
either a tuberculoma or gumma. 

Histopathology showed it to be a large caseat- 
ing tubercular mass with discrete tubercles in 
periphery; lungs miliary tubercles; larynx: Tu- 
bercular laryngitis; spleen: While grossly failed 
to show tubercles in microscopic section, miliary 
tubercles were noted; pancreas revealed small 
tubercles with tuberculous reaction on serous coat 
in microscopic section. 

Pulmonary Tuberculosis with Extensive Cavita- 
tion of Both Upper Lobes. — M. S., a colored male, 
aged 40 years, entered this hospital on January 3, 


50 


Case Reports and Clinical Suggestions 


1931, with diagnosis of laryngitis, cause undeter- 
mined. A good history was difficult to obtain 
because of the extreme weakness of the patient 
and his virtual inability to talk. He had had pain 
in his chest for several years. Hoarseness and 
pain in throat was 2 months in duration. During 
the two months there had also been progressive 
weight loss, fever, night sweats and a chronic 
productive cough. 

On examination the patient showed typical 
phthisical facies. The findings in the chest were 
in keeping with this general impression and 
pointed to extensive involvement of both lungs 
from 5th to 6th dorsal spines and 3rd ribs up on 
both sides with possible cavitation. 

The roentgenogram of the chest was of especial 
interest because on first observation it gave the 
impression of collapse of the upper half of both 
lungs. On closer examination, however, the sup- 
posed collapse was considered as extensive cavi- 
tation. 

The case was terminal on arrival at the hos- 
pital and the patient progressively grew weaker 
and died on January 8, 1931. 

At autopsy the clinical diagnosis of extensive 
cavitation of both apices was born out. The 
specimen here shows how the entire parenchyma 
of the upper lobe has been destroyed and the 
tuberculous involvement of the lower lobes. The 
other lung presented essentially the same picture. 

Actinomycosis of the Brain. — M. C., a colored 
male of 37 years, came into the hospital on Octo- 
ber 18, 1930, complaining of inability to use his 
left arm. 

His father, mother and two brothers had died 
of pulmonary tuberculosis. 

October 17, 1930, a tingling sensation was 
noticed in his left fingertips. This was followed 
shortly by a period of unconsciousness and on the 
return of consciousness inability to use the left 
arm was apparent although he was able to walk. 
On the nineteenth and twenty-first of October he 
had two similar attacks, the last leaving him un- 
able to walk. On October 22 he had had pains 
up and down his back. 

The important physical findings were that the 
pupils were dilated and reacted suggishly to light. 


The tongue on protrusion deviated to the left side. 
A spastic paralysis of the left arm and leg was 
present; patellar reflexes left-hyperactive; right- 
hyperactive; biceps-left hyperactive; rightnormal. 
Nuchal rigidity was present. Brudzinki’s sign 
was positive; left facial weakness. 

Spinal fluid, October 22, showed 3 plus globulin 
and was cloudy. Total cells numbered 1346, 
largely polymorphonuclears. Smearls of cen- 
trifuged specimen with Gram’s and acid fast 
stains were negative for micro-organisms. Spinal 
fluid pressure was 30 m.m. and rose to 38 m.m. 
on jugular pressure. 

A diagnosis of cerebrospinal meningitis of un- 
determined cause was made and intensive treat- 
ment with various brands of antimeningococcic 
sera was immediately begun, being given intra- 
spinally 3 times a day during the first four days, 
of his illness, twice a day for next 2 days, and 
once a day thereafter. No satisfactory response 
was noted to serum treatment. A terminal lobu- 
lar pneumonia was noted on October 30 and 
patient lapsed into coma and died October 31. 

Routine urine, feces, sputum and blood Wasser- 
mann were negative on admission. All speci- 
mens of spinal fluid were consistently negative for 
micro-organisms. 

Pathological findings: The base of the brain 

showed considerable infection throughout. An 
abscess was demonstrable on the middle of left 
temporal lobe. There was some increase in the 
inflammatory response between cerebrum and 
cerebellum. Microscopic tubercles were not dem- 
onstrable. The medulla and upper portions of the 
cord also showed some inflammatory response. 
The upper surface of the brain was intensely con- 
gested and showed relatively little exudate 
although there was some clouding of the pia 
arachnoid. Palpation of the surface revealed an 
abscess cavity in the upper parietal portion of the 
right cerebrum. Smear from the abscess was re- 
ported as follows: “Gram positive pleomorphic 

streptothrical organisms seen with variation in 
size and many are beaded.” 

Histopathology showed meningeal reaction 
characterized by endothelial cells predominating. 
Right kidney showed an abscess 4 c.m. by 2 c.m. 
at its lower pole with an associated acute pyelitis. 


Editorials 


51 


NEW ORLEANS 


Medical and Surgical Journal 

Established 181*1* 

Published by the Louisiana State Medical Society 
under the jurisdiction of the following named 
•Journal Committee: 

S. C. Barrow, M. D., Ex-Officio 
For one year: W. H. iSeemann, M. D., 

Randolph Lyons, M. D., Secretary 
For two years: John A. Lanford, M. D. 

For three years: S. M. Blackshear, M. D., 

H. W. Kostmayer, M. D., Chairman. 


EDITORIAL STAFF 

John H. Musser, M. D Editor-in-Chief 

Leon S. Lippincott, M. D Editor 

Willard R. Wirth, M. D Editor 

H. Theodore Simon, M. D Associate Editor 

Frank L. Loria, M. D Associate Editor 

D. W. Jones, M. D Associate Editor 

Jacob S. Ullman, M. D Associate Editor 


COLLABORATORS— COUNCILORS 


For Louisiana 
H. E. Bernadas, M. D. 
Daniel N. Silverman, M. D. 
C. C. DeGravelles, M. D. 

•J. B. Benton, M. D. 

C. P. Gray, M. D. 

J. H. Slaughter, M. D. 

D. C. lies, M. D. 

J. H. Landrum, M. D. 


For Mississippi 
J. W. Lucas, M. D. 

L. L. Minor, M. D. 

M. W. Robertson, M. D. 
Thomas J. Brown, M. D. 
Willie H. Watson, M. D. 
W. G. Gill, M. D. 

Jos. E. Green, M. D. 

•J. W. D. Dicks, M. D. 

D. J. Williams, M. D. 


Paul T. Talbot, M. D General Manager 

1430 Tulane Avenue 

SUBSCRIPTION TERMS: $3.00 per year in 
advance, postage paid, for the United States; $ 3.50 
per year for all foreign countries belonging to the 
Postal Union. 

News material for publication should be received 
not later than the twentieth of the month preced- 
ing publication. Orders for reprints must be sent 
in duplicate when returning galley proof. 

The Journal does not hold itself responsible 
for statements made by any contributor. 

Manuscripts should be addressed to the Editor, 
11*30 Tulane Avenue, New Orleans, La. 


THE AMERICAN MEDICAL ASSO- 
CIATION IN NEW ORLEANS. 

The decision of the House of Delegates 
of the American Medical Association to 
come to New Orleans for their Annual 
Meeting in 1932 is one which has been re- 
ceived with a great deal of enthusiasm by 
the local doctors in the city and one which 
we presume will be received with equal 
ardor by the doctors of Louisiana, as well 
as those in Mississippi. The Annual Meet- 
ing of this great Association is one which 
is unsurpassed by any convocation of any 


medical organization in the country. There 
is proffered to the physicians a magnificent 
program, which is supplemented by a scien- 
tific exhibit which graphically illustrates 
recent advances in medicine. To the scien- 
tifically inclined physician or to the one who 
is anxious to learn, more information may 
be obtained during the week that the 
American Medical Association holds forth 
than by any other method of instruction in 
which we are familiar. One of the minor 
features, but no less important at least to 
some men, lies in the fact that it is possible 
judiciously to interchange the scientific 
with the social. Entertainments are pro- 
vided for the socially inclined, and for the 
wives of the doctors also an interesting 
program is arranged. 

It would seem that now would be a par- 
ticularly appropriate time for those doctors 
not in organized medicine to become mem- 
bers of their Parish and State Societies, so 
that they may ultimately become members 
of the great mother of American medicine, 
participate in the advantages of member- 
ship, and become a'ctive protagonists of 
organized medicine. Unfortunately, these 
suggestions will not reach the eyes of the 
men who are not members of the State 
Society, but to those that read these para- 
graphs and who are workers in organized 
medicine let it be suggested that they place 
before their brothers without the fold the 
advantages of membership in the state 
leading to ultimate membership in the 
national organization, so that Louisiana 
and Mississippi may come to the approach- 
ing meeting of the American Medical 
Association with a very large percentage 
of the doctors in the State fellows of the 
organization, who, appreciating the advan- 
tages of membership when they attend the 
Annual Meeting, will permanently become 
active workers in organized medicine. 

Now is the time for Louisiana and 
Mississippi doctors to join their State 
societies. Let us all now get after the man 
who is without and on the outside. 


52 


Editorials 


UNDULANT FEVER. 

It is rather interesting to speculate upon 
some of the infections which might by 
chance be called new, in that their recog- 
nition or the appreciation of them is lacking 
up until a comparatively few years ago. 
Two outstanding examples of this, undulant 
fever and tularemia, are obvious, two dis- 
eases which have apparently only been 
present in civilized communities or in cer- 
tain sections of the world within the last 
several years. 

A recent Milroy lecture by Surgeon 
Captain Dudley discusses, after a careful 
survey of naval records of a hundred years 
ago, the explanation as to why undulant 
fever should be at the present time rela- 
tively common. In the British Navy un- 
du'ant fever was extremely rare prior to 
1855. By 1882 its incidence had doubled. 
This increase may be explained by the fact 
that goat’s milk was not barred from the 
ships nor were the men prevented from 
drinking it. When the ship’s crew were 
forbidden to take goat’s milk undulant 
fever promptly disappeared, but recently it 
has come about again that the disease is 
prevalent and present in the ships that are 
on the Mediterranean service. This is now 
attributed to the presence of Br. abortus in 
cow’s milk. This organism, however, was 
known to be present in infected cows since 
1897. Something has occurred which has 
made this particular germ pathogenic for 
man. Theobald Smith has called attention 
to this particular type of undulant fever, 
saying that its presence can not be ex- 
plained merely because the disease escaped 
the notice of American doctors prior to 
1922. What probably has happened has 
been that either these brucefia infections of 
cattle as they occur in the United States or 
in English ships, are due to an increase in 
the infectivity of the bovine type, or else 
the caprine strain has been imported and 
is now infecting animals. In certain coun- 
tries, as for example Porto Rico, there have 
been no human cases of undulant fever, 
although the infection rate of cattle with 


Br. abortus is extremely high. Dudley 
assumes from these facts that the organism, 
an occasional parasite, has wandered away 
from its specific host to adapt itself to a 
purely human environment. 


PAPERS FOR PUBLICATION. 

The editorial staff of a journal owes its 
first and greatest duty to the readers. The 
guiding principle of the editors of lay 
journals is to “give the public what it 
wants.” This is equally the case in medi- 
cal journalism. Therefore, the unpleasant 
task of returning a manuscript frequently 
comes up. 

Why is it necessary to reject a paper? 
The most common reasons for rejection are : 
there are too many on the same subject 
already, the theory advanced is not sup- 
ported by the facts, a talk before a medi- 
cal society may be the basis of a good 
discussion, or may be an excellent resume 
of a subject, and as such is well worth while 
on the program of a medical society, but 
since it is composed of nothing but what 
has lo^g been found in textbooks it is un- 
fair of the society to ask that the journal 
devote space to an article that does not 
establish new facts or methods of treat- 
ment ; that does not set forth the results of 
research or experience; or that does not 
stimu’ate the reader to think or enable him 
to arrive at worthwhile conclusions. 

A journal has, necessarily, a limited 
amount of space to devote to papers. To 
publish everything that is sent in would 
cause a printing expense that spells bank- 
ruptcy. The readers would soon raise a 
storm of protest because of the constant 
repetition. 

The society may find other ways of com- 
plimenting an essayist without nonchalantly 
voting that his paper be published. As soon 
as the applause has subsided a moment de- 
voted to reflection should suffice in deter- 
mining whether the essay measures up to 
the standards of practicability, timeliness 


Hospital Staff Transactions 


53 


and originality. Of course, after some 
hasty, or thoughtless, member has moved 
that the paper be published, few have the 
backbone to go to the aid of the long- 
suffering and over-worked editor, at the 
risk of offending the essayist, by suggesting 
that, while the paper was most interesting 
and well presented, it is not necessarily of 
the type that the journal publishes. 


HOSPITAL STAFF 

MISSISSIPPI STATE HOSPITAL. 

Fondren, Mississippi, May, 1931. 

Abstract: Bromide Intoxication. — R. B. Zeller, 

M. D. The patient, a white male, age 36, was 

admitted to the hospital March 17, 1931; occu- 
pation, reporter. 

Present Complaint: Restlessness, talkativeness, 

unsteady gait, speech thick and indistinct. 

Previous History: Has used alcohol periodical- 

ly since the age of 20, having been arrested sev- 
eral times for drunkenness and has taken treat- 
ment for alcoholism at least twice; gonorrhea in 
February, 1931. Has always been hypersensitive 
and emotionally unstable. 

Physical Examination : A well nourished white 

male. Blood pressure 117/80; chest normal. Deaf 
in left ear with absence of the tympanic mem- 
brane. No rash. Face droops slightly on right. 
Deep reflexes exaggerated. A slight urethral dis- 
charge. Some incoordination of extremities. 

Mental: Patient was euphoric with flight of 

ideas. Correctly oriented. 

Serology: Blood Wassermann and spinal fluid 

negative. Blood bromide — over 300 mg per 100 cc. 

Course: On March 19, the patient still con- 

fused mentally, tried to light a cigarette on an 
electric light bulb. Sleep continued disturbed. 

March 22, remains slightly elated, still restless 
and talkative but less emotional. 

March 25, Blood bromide concentration between 
175 mg and 200 mg per 100 cc. 

April 1, Blood bromide concentration 75 mg 
per 100 cc.; patient much less restless. 

April 5, patient appears normal mentally. The 
urethral discharge has disappeared. 

April 9, blood examination at this time shows 
no trace of bromides. He was discharged as re- 
stored on April 13, 1931. 


It is respectfully suggested that the 
officials of local societies might save them- 
selves and the editors the necessity of 
making unpleasant explanations by the 
addition to their by-laws of a provision to 
govern the publication of essays presented 
to the society. 

J. S. Ullman, M. D. 


TRANSACTIONS 

Diagnosis: The thickness of speech and 

marked incoordination of the extremities with his 
correct orientation suggested more than an alco- 
holic intoxication. The examination for bromides 
established the diagnosis. 

Treatment: Sodium chloride tablets, 60 grains 

each, given dissolved in a glass of water four 
times a day, treatment being instituted the day 
after admission and continued until April 5. 
Serenium, grains IV 2 three times daily used for 
the urethritis. Continuous baths, sixty minutes 
each, at 95° F., given daily. 

Comment: Patient claimed a physician had 

given him some medicine for insomnia with in- 
structions to take some when he felt bad. As 
he felt bad most of the time, he had the prescrip- 
tion refilled. It suggests itself that it might be 
well to caution patients when giving bromides. 

Abstract: Carcinoma of Pancreas with Cholyli- 

thiasis. — R. B. Zeller, M. D. 

Patient: A white female, aged 63 years, mar- 

ried, admitted to the Mississippi State Hospital 
in 1905 with an uneventful record until the pres- 
ent. Mental Diagnosis: Schizophrenia. 

Complaint: On March 27, 1931, patient 

showed loss of appetite and expressed a desire to 
remain in bed. 

Family History: Mother died at age 60 from 

“liver trouble.” 

Personal History: Yellow fever at age 36. 

Physical Examination: Patient was obese with 

a normal pulse, temperature and respiration. No 
abdominal masses could be palpated, no pain or 
tenderness. March 30, slight jaundice of the 
skin first noticed. 

Urinalysis: Acid reaction; sp. gr. 1018; albu- 

men present; fatty and granular casts noted. 

Stools: No parasites, occult blood or undi- 

gested fat particles noted. 


54 


Hospital Staff Transactions 


Blood: Erythrocytes, 3,200,00; Hb. 46 per 

cent; leukocytes 7,600 with 76 per eent polymor- 
phonuclears; Wassermann reaction negative; 
Blood sugar 170 mg per 100 cc.; Van den bergh 
8.6 mg. per 100 cc.; icterus index 11.2; sedimen- 
tation index (1 hr) 31. 

April 1, jaundice progressively increasing. 
Heart action continues strong. Abdomen flat and 
without tenderness. 

Diagnosis: Considering the age of the patient, 

the deepening painless jaundice, the secondary 
anemia, marked sedimentation index and evi- 
dences of obstruction, a diagnosis of carcinoma 
of the head of the pancreas was made. 

Course: On April 8, patient complained of in- 

creasing weakness, but able to get out of bed 
at times. 

April 15: Urine alkaline in reaction with neither 
albumen nor casts. Pulse rate 80; temperature 
98.2; respiration 18. 

April 19: Temperature 100, pulse 128, respira- 
tion 40. Patient still does not complain of either 
pain or tenderness. Appetite is poor. 

April 20: Patient died this afternoon. Was 

drowsy and showed considerable respiratory dis- 
tress just before the end. 

Autopsy: At autopsy, Dr. D. D. Baugh found: 

An obese elderly female, jaundiced, post mortem 
lividity present. Chest apparently normal ex- 
cept for hypostatic congestion. No excess of 
peritoneal fluid found. Liver normal in size, 
edges rounded and gall-bladder showed a thick- 
ened wall; twelve stones were removed from 
the bladder with four to six facets each, varying 
in size from a marble to a small pea, smooth 
brownish cholesterine composition. Total weight 
of stones 16.5 gs. Two smaller stones were re- 
moved from cystic duct; none found in common 
duct and no purulent material. Following the com- 
mon bile duct downward, a hard mass was found 
which held the duct in its border. The mass, 
which proved to be the head of the pancreas was 
firm, nodular, flattened, and the size of an apple. 
The remaining part of the pancreas and the 
other abdominal viscera were grossly normal in 
appearance. 

Comment: The insidious onset without any 

complaint except that of weakness and the rapid 
termination of the case were of interest. The 
stones found in the gall-bladder which apparently 
had caused no inconvenience were also of in- 
terest. 


VICKSBURG SANITARIUM AND CRAWFORD 
STREET HOSPITAL STAFF MEETING. 

JUNE 10, 1931. 

Abstract: Fracture of Cervical Vertebra. — Dr. 

A. Street. 

Patient: White, female, aged 42, married, one 

child. 

Complaint: Fell backward from a swing ten 

days ago and was unconscious for about six 
hours. Since the accident, there has been much 
pain, which is sharply accentuated by head 
motion. There has been no paralysis, no areas 
of anesthesia and no paresthesia. No headache. 
General health, appetite and digestion are good. 

Physical Examination: There is sharp pain 

in the neck on active or passive rotation of the 
head. There is tenderness elicited by pressure 
on the spinous processes of the fourth and fifth 
cervical vertebrae. Examination otherwise not 
remarkable. Temperature normal. 

Examination of blood and urine showed noth- 
ing abnormal. 

Roentgen-ray examination showed fracture of 
the lower anterior portion of the body of the 
fifth cervical vertebra with the fragment dis- 
placed downward and forward. 

Treatment: The neck was immobilized by 

application of plaster to shoulders, neck and head. 

Discussion : The most important element of 

fractures of the spine is damage to the cord, and 
in the days before the common use of roentgen- 
ray diagnosis, spine fractures were occasionally 
diagnosed on the finding of evidence of cord 
damage alone. Since perfection of roentgen-ray 
technic and its extensive use in spine injuries, 
many fractures, without cord symptoms and with- 
out visible deformity, are being detected that 
formerly would have been overlooked. 

Abstract: Carcinoma of the Cecum. — Dr. J. A. 

K. Birchett, Jr. 

Patient: White, female, aged 64, married, five 

children. Admitted to hospital May 7, 1931. 

Chief Complaint: Lump in lower abdomen 

with cramp-like attacks of pain. 

History of Present Complaint: Has noticed 

a sense of fullness or weight in the right lower 
abdomen for the past year: has gradually in- 
creased in severity. For the last six months has 
noticed that mass seemed to get larger at times 
with severe colicy pain and sensation of some- 
thing moving in the abdomen. While working. 


Hospital Staff Transactions 


55 


as stooping over flower bed or leaning over, the 
pain would come on suddenly and be lancinating, 
abating as soon as position was chaged. Has 
been troubled with constipation for (the last 
five or ten years; now always has to take a laxa- 
tive to get bowel movement. No intermittent 
attacks of diarrhea; never passed any blood or 
mucus from bowel in any large amounts but has 
been known to have had what she thought was 
bleeding piles two years ago. 

Post History: Has had five children; no oper- 

ations. For past two years has been suffering 
with severe headaches and vertigo and has been 
told that she had severe kidney disease. No 
digestive disturbance except constipation which 
is getting progressively worse. Bowel move- 

ments lately have been accompanied by ; a'n and 
straining. Has marked palpitation and dyspnea 
on exertion but this is relieved by rest. Had 
menopause at 41; no discharge or bleeding since 
that time. 

Family History: An adopted orphan; no ante- 

cedent history obtainable. 

Physical Examination: Small, rather poorly 
nourished white female, past 60 years of age; 
walked into clinic. Hair gray; false teeth; throat 
negative; no thyroid enlargement. Heart rate 
88; no murmurs. Blood pressure 190/100; lungs 
negative. Abdomen shows some gaseous disten- 
tion and a mass in right lower quadrant in region 
of cecum, freely movable, seeming to get smaller 
under gentle pressure but patient complains of 
pain upon manipulation. Pelvic examination not 
permitted. Skin rather dry and slightly dis- 
colored; extremities negative. 

Procedure: From the history of bowel dis- 

turbance and severe constipation, it was thought 
that the palpable mass was a tumor in connection 
with the colon, in the vicinity of the cecum. For 
this reason a barium meal was given to follow 
the passage of the barium and to outline the exist- 
ing mass. Before the meal was given, however, 
a barium enema was given which stopped at the 
upper border of the mass, which was found to 
extend into the ascending colon. The barium 
meal given the next day showed a narrowed lumen 
of the cecum and ascending colon with only a 
small trickle of barium passing through. From 
this evidence, a diagnosis of an obstructing mass 
in the ascending colon and cecum, probably 
malignant, was made and exploratory operation 
advised. 

One week of preliminary treatment included 
enemata daily to lower bowel, the administration 
of glucose intravenously and daily stomach lavage 
to educate the patient and get her accustomed to 


the use of the tube so necesary as a post opera- 
tive means of treatment. 

Surgical Procedure: Under spinal anesthesia, 

a long right rectus incision was made. The peri- 
toneum was normal. The mass noted at exami- 
nation was a large, indurated cecum with edema- 
tous congested appendix. The terminal ileum 
for a distance of ten to fourteen inches was 
leathery in appearance and feel and twice the 
normal size. No visible peristalsis in this portion 
of intestine. The cecum was movable but at- 
tached to right pelvic and lumbar shelf posteri- 
orly due to old inflammatory bands. There were 
enlarged glands posterior and in mesentery. The 
adhesions were gradually freed and the cecal 
mass lifted out of wound as the peritoneal reflec- 
tion was cut away posteriorly. The ascending 
colon was ligated between intestinal clamps and, 
placed well above the annular growth, the distal 
end of colon closed and turned in making a blind 
pouch. The next step was the securing of the 
blood supply of the cecum, which was done care- 
fully and close to cecum to avoid the middle colic 
artery and its main branches. With the ligation 
of the mesentery, the terminal ileum was divided 
two inches from the ileo-cecal valve and the 
proximal end turned in and closed. Six inches 
from the end the ileum was anastomosed, side 
to side to the transverse colon and the end of 
the ileum brought out of the lower end of the 
wound to be opened later if enterostomy was 
thought advisable. 

Subsequent: Patient was in good condition at 

close of operation. Blood pressure 140/90; pulse 
120. The post-operative period was uncompli- 
cated for the first 96 hours on intravenous glucose 
twice daily and gastric lavage with duodenal 
tube; no rise of temperature and no evidence of 
peritoneal irritation, no abdominal distention. 
There are passages of gas from lower bowel 
with small amount of fecal matter which was evi- 
dence of functioning ileo-colostomy. On the 
morning of the sixth day, patient began to com- 
plain of headache and developed delirium with 
accelerated pulse rate, up to 140. Pulse full and 
strong. No evidence of hemorrhage. Blood, 
pressure was 150, systolic. The cerebral condi- 
tion was judged to be of toxic origin and at this 
stage 500 cc. of citrated blood was given in the 
vein but with no improvement in the mental 
condition. Patient gradually went from delirium 
into coma and died on the seventh post-operative 
day. The pulse at death was 70 with rapid 
respiration suggestive of Stokes-Adams syndrome, 
but atropine gave no improvement. A post mor- 
tem was requested but refused. 

Discussion: The reason for presenting this 

case is to bring out two points: 1. Whether we 


56 


Hospital Staff T ransacti,ons 


were justified in a one stage operation in this case. 
I believe the outcome would have been the same 
following a primary ileo-colostomy before the 
complete resection for I think that in this case 
the immediate cause of death was a cerebral 
complication. There was no evidence of any 
disturbance within the peritoneal cavity. 2. The 
many complications that can arise in surgical 
patients which are past 60 years of age: the 
older the patient the more the risk. 

Abstract: Subacute Mastoiditis with Rupture 

Internally and Externally. — Dr. C. J. Edwards. 

On May 18, at 8:40 p. m., Master T. H. walked 
in for examination of the ear. He was a boy 
ten years of age, slight in build, small for his 
age, with a stiffness of the neck on right side, 
with head inclined towards left. Had not been 
confined to bed. Gave history of earache three 
months previously with purulent discharge. 
Swelling was of two days duration. No pain 
but interfered with movement of head. 

Physical examination revealed a right purulent 
ear, a swelling about the size of a lemon over 
the mastoid area, extending upward. Moderately 
enlarged glands of the neck on right side only. 
Swelling did not pit on pressure. Roentgen-ray 
showed a dense shadow over mastoid. Blood 
showed leukocytes, 19,400; neutrophiles 65 per 
cent. Temperature 99.8°F.; pulse 110. Immedi- 
ate operation was advised and consented to. 

Under ether anesthesia, an incision was made 
through the swelling down to the mastoid. With 
a hoe-shaped periosteal elevator the periosteum 
was removed. During this act external table v;aj 
broken through with escape of about two drams 
of pus and exposure of dura and lateral sinus. 
As this opening was enlarged it was found to 
extend backward and inward exposing the lateral 
sinus and dura which were covered with granu- 
lations. A small walled off abscess about one 
inch long by one-half inch wide between the 
dura and the skull extended backward and inward. 
The whole external tip of the mastoid was necrotic 
as well as the internal plate. The mastoid tip 
was lifted out and severed from the muscle with 
scissors. 

Pulse and respiration became bad and only a 
light curettement of granulations on the lateral 
sinus and dura was done. An iodoform pack was 
placed in the cavity and incision closed. 

On the third day the temperature rose as high 
as 101 °F. and then gradually subsided on the 
fourth day, never later rising above 99 °F. The 
dressing was kept wet with Dakin’s solution 
and was not removed for forty-eight hours, when 
a new one was applied. Patient was discharged 


on his eighth day of ilness, practically cured, 
still having a wick in the lower part of wound 
to facilitate drainage. 

Pus from mastoid showed Bacillus mucosus 
capsulatus. 

Abstract: Double Vagina With Two Distinct 

Uteri. — Dr. S. W. Johnston. 

My report this evening is of a negro woman, 
aged 24, who came to me on May 3, suffering 
with frequent attacks of nervous indigestion. 

On physical examination, I found a well 
developed colored female, weight 115 pounds, 
height 64 inches. Her breasts were well developed 
and her general condition seemed to be above 
that of the average negro woman. Her blood 
pressure was 118/70. 

She gave a history of menstruating regularly 
since the age of 13; no pregnancies nor any irregu- 
larity of menstrual flow. On vaginal examination, 
I found two perfectly developed vaginas, one 
anterior to the other. There was a well developed 
fold completely separating the anterior from the 
posterior. The posterior had evidently been used 
most in coitus because it was larger and the 
walls showed fewer vaginal folds. There were 
two distinct cervixes and both uteri seemed well 
developed. 

I have instructed this woman to report to me 
during her menstrual period so as to ascertain 
if both uteri function together. I shall report to 
you later my findings. 

CLINICO-PATHOLOGICAL MEETING OF 
OUR LADY OF THE LAKE SANITARIUM. 

BATON ROUGE, LA. 

The Clinico-Pathological Meeting of Our Lady 
of the Lake for the month took place on May 27, 
with the following members of the Staff present: 
Drs. K. Irwin, W. H. Cook, H. G. Riche, J. H. 
McCaa, W. H. Pipes, C. A. Weiss, R. McMahon, 
R. C. Kemp, T. J. McHugh, H. W. A. Lee, Cecil 
Lorio, Jas. M. Adams, T. S. Jones, J. J. Robert. 
Dr. Riche presided over the meeting. 

The cases presented were: Cardio-renal syn- 
drome, with autopsy, Dr. H. W. A. Lee; Fibro- 
cystic disease of the breast, three cases, Dr. 
Kernan Irwin. 

The following is a brief resume of the cases: 

Dr. H. W. A. Lee. 

Mrs. K. G. aged 80 years, white female. 

Chief Complaint: On March 27, 1930, patient 

was first seen by the attending physician on 


Hospital Staff Transactions 


57 


account of vomiting coffee ground substance. 
She had a vomiting spell the day before and 
vomited about half a basin of this substance. 
When I saw her she was nauseated and had vom- 
ited a brownish fluid. Bowels have not moved 
for 3 or 4 days. 

Physical Examination: Temperature 99°, pulse 

80, blood pressure 186/108. Chest negative ex- 
cept for a slightly enlarged heart. Abdomen is 
enormously distended (which she has had for a 
year). Very tender over the epigastrium and pa- 
tient would not allow palpation to any extent. 

Past History: Patient broke her hip about 

4 or 5 years ago and has never walked since. 

Progress Notes: When I saw this patient 

March 27, she showed no signs of hemorrhage. 
I had an enema given and a prescription of novo- 
caine. All food was stopped for 24 hours. Ad- 
vised hospitalization and roentgen-ray but this 
was refused. She refused to take her medicine 
after a day or two. Her bowels would not move 
except by enema and the nurse said her stools 
were never black but light yellow. 

I saw her again April 8, when she complained 
of nausea and vomiting. Her bowels had not 
moved since April 1. I saw her again on April 
9 and 10 while she seemed to be all right. I 
was called again on the twenty-first and found 
her bowels had not moved for a week although 
she said she had taken a considerable quantity 
of purgative. 

On the first of May she was complaining of 
nausea and had a severe pain in the right foot. 
This pain had begun several days before. On 
examination of the foot, there was found to be 
gangrene of the great toe and slight discolor- 
ation of all of the other toes. Pulse 90, tempera- 
ture 99.5°. I could not make out any definite 
heart lesion and the sounds were very distant 
and inaudible. She was given digitalis and 
morphia. Her leg and foot were wrapped in 
cotton batting and external heat applied. The 
gangrene gradually spread up to about the junc- 
tion of the lower and middle third of the leg. 
Her urine was negative for sugar. It contained 
a trace of albumen. She had to have a daily 
enemata for her bowels until about two days 
before her death when she developed a diarrhea. 
Her abdomen then went down. On the afternoon 
of her death, she had a chill and died in five 
minutes. 

Autopsy Protocol: Mrs. K. G. Body of white 
female, very well nourished, 63 inches long, about 
80 years old. No rigor mortis, post-mortem 
lividity present. There is gangrenous condition 
of the right foot which extends to above the 


ankle to about the junction of the lower and 
middle thirds of the leg. 

Chest: Lungs apparently normal. There are 

old pleuritic adhesions posteriorly and at the apices 
of both lungs. Heart is slightly enlarged. There 
is a very distinct hardening of the coronary 
arteries. Ribs break very easily. Sternum soft. 

Abdomen: Stomach was contracted so that it 

measures about 2 % inches in diameter at the 
cardiac end and about 2 inches just above the 
pylorus. Externally the stomach was hyperemic. 
The mucosa was intensely hyperemic and there 
were petechial hemorrhages. Rubbing with the 
back of the knife produced a large amount of 
blood. The microscopical examination shows an 
hyperemia of the mucosa. There is no leukocytic 
infiltration. There are petechial hemorrhages. 
There is no malignancy. The muscularis is 
apparently normal. 

The liver is mottled yellow and red, nodular. 
There is a small amount of exudate along the 
anterior edge. The cut surface shows an increase 
of connective tissue. The microscopical examin- 
ation shows an increase of connective tissue, fatty 
degeneration of the liver cells. There are some 
areas that show hyperemia. 

Gall-bladder is negative. 

Spleen measures 11x4x5 cm. Soft. Capsule 
smooth. There are several small white nodules 
resembling tubercles. On section the pulp scrapes 
off easily and the trabeculae are rather well 
marked. The microscopical examination shows a 
rather large amount of pulp. These are areas 
near the capsules that gives the impression of 
tuberculosis. 

Kidneys measure 9x5x4 cm. They are small, 
contracted, capsule peels with difficulty and leaves 
a rough surface. There are numerous cysts of 
various sizes filled with clear fluid and some with 
bloody material. There are several small, white, 
areas under the external surface and on the 
papnllae which give the impression of subercles. 
The microscopical examination shows an intense 
hyperemia with cloudy swelling of the epithelium 
and some destruction of same. There is a large 
increase of connective tissue. The tubules are 
constricted or closed in certain areas with cystic 
dilatation above. Some of the glomeruli have 
undergone fibrosis. The small white areas give 
the impression of being tuberculous. 

Pancreas is apparently normal. The microscop- 
ical examination is negative. 

Intestines and appendix are negative. 

Uterus and adenexa are negative. 


58 


Hospital Staff Transactions 


All of the vessels of the mesentery, pancreas, 
spleen, and some of the stomach show an extreme 
condition of arterio-sclerosis. 

Diagnosis : 

Hepatitis, atrophic 

Spleenitis 

Nephritis, interstitial 

Hemorrhages of the stomach 

Arteriosclerosis 

Gangrene of foot. 

Mrs. Ruby S., age 25, white female. Admitted 
May 17, 1931. Discharged May 24, 1931. 

Chief Complaint: For the past month patient 

has complained of pain in the left breast. It was 
sensitive and very much enlarged. In April, 1930, 
she had a small fibroma removed from the left 
breast and she said that she had been conscious 
of it for three years. At the same time, breast 
tissue was removed from the right breast and 
she had no trouble since that time. As soon as 
the pain and swelling was felt three weeks ago, 
patient became alarmed as it was the second time 
she had trouble with the left breast. 

Past History: She had two children and three 

miscarriages. She was operated in 1930 for 
chronic mastitis of right breast and fibroma of 
left breast. 

Physical Examination: Both breasts show a 

small scar about two inches long radiating from 
the nipples. Left breast about one quarter larger 
than the right. There is a diffuse mass which is 
somewhat nodular and firm. Painful on palpa- 
tion. There is some enlargement of the axillary 
lymph glands. 

Laboratory Examinations: Urine; acid, 1.034, 

trace of albumen. Blood; WBC 4,850, L 33, M 2, 
P 63, E 1, B 1. 

Left breast was removed in toto on May 18. 

Tissue examination: Breast measure 14x8x3 

cm. Nodular. On section there are numerous 
white, hard masses and streaks. Microscopical 
examination shows an hyperplasia of connective 
tissue with apparently some acini formation. 
There are no apparent signs of malignancy: fibro- 
adenoma. 

Mrs. E. B. H., age 43, white, married. 

Past History: In 1927 patient complained of 

soreness of left breast before each menstruation 
for some time. In August she developed a nodule 
of irregular shape occupying the middle of the 
breast. It was attached to the nipple. Hard and 
quite sensitive. No involvement of the axillary 
glands. Mammectomy was performed. The path- 
ological report showed a cystic fibro-adenoma. 

Present complaint is now the right breast has 
a feeling of soreness previous to each menstrua- 


tion. She has been treated for some time with 
roentgen-rays. This has apparently diminished 
the size of the “lump” in the breast. The im- 
provement has only been temporary. She was 
advised by the attending physician to have the 
breast removed. 

Physical examination is negative except for 
a large mass in the right breast. This is appar- 
ently in the glandular tissue. There is no in- 
volvement of the axillary glands. 

Laboratory Reports: Urine; acid, 1,030, nega- 

tive. Blood, WBC 8,050, L 31, M 11, P 57, E 1. 

Tissue: Right breast measures 15x15x6 c.m. 

There is a rather firm mass over the center of 
the breast. On section there is apparently a large 
increase in connective tissue. This is rather irreg- 
ular in shape and infiltrates into the surrounding 
tissues. There is apparently an increase in acini 
formation which are surrounded by a thick layer 
of connective tissue. In certain areas there is 
apparently a proliferation of new connective tis- 
sue. In other areas there are a few scattered epi- 
thelial cells. These last two are probably due to 
the roentgen-ray treatments. There is a general 
increase in the connective tissue: fibroadenoma. 

Mrs. P. H., age 46, white, widow. This patient 
has a hard lump in the right breast for some time. 
This is painful at times. 

Physical examination negative except for mass 
in the right breast. This is hard and in the breast 
tissue. 

Laboratory examination: Urine; acid, 1,020, 

faint trace of albumen. Blood count, WBC 4,750, 
L 27, M 5, P 66, E 4. 

Tissue: Right breast measures 13x13x5 c.m. 

The largest part of the center is occupied by a 
large white mass which radiates into the sur- 
rounding fatty tissue. In the center of the mass 
there is a large hematoma which is organizing. 
This measures about 2.5 cm in diameter. The 
microscopical examination shows an hyperplasia of 
connective tissue. There is apparently some in- 
crease in the number of acini. No malignancy 
could be found: fibroadenoma. 


HOTEL DIEU. 

The regular monthly meeting of the Visiting 
Staff of Hotel Dieu was held Monday, June 18, 
Dr. Theo. J. Dimitry presiding. 

The scientific program comprised: 1. The pres- 

entation of a case of Brain Abscess by Dr. Homer 
Dupuy, abstract of which follows: 

This is a case handled by Dr. Jules Dupuy and 
myself; we had the assistance of Drs. Francis 
Murphy, A. Anderson, and J. T. Nix, and there 
is glory for everyone. For we are demonstrating 
a victory as we believe the patient to be entirely 


Hospital Staff Transactions 


59 


cured, and at the time of operation, mortality 
was 75 per cent. 

It began as a case of chronic recurring otorrhea. 
The original infection was in the middle ear. 
When the patient first came to us he was showing 
symptoms of brain abscess — very apathetic and 
of slow mentality. There had been intense head- 
aches. 

Mastoidectomy was performed as a result of 
roentgen-ray investigation, and the pain ceased, 
but patient continued apathetic, and, four days 
after the operation, developed edema of the facial 
nerve (third branch) on the opposite side. 

On June 6, the following day, patient gave a 
very remarkable sign of trouble in the temporal- 
sphenoidal lobe — word aphasia — inability to con- 
nect names of objects with the objects themselves. 
The infection of the middle ear had probably 
gone to the brain first and then to the mastoid. 

Craniotomy was performed on June 7. Foul 
pus found as soon as the dura was entered. The 
whole temporal lobe was exposed; exposure over 
the middle ear showed dura covered with granu- 
lation tissue. The abscess, fortunately, was sur- 
rounded by a very thick capsule. At least three 
ounces of pus were removed, and a rubber dam 
drain left in the wound. 

Word asphasia continued even after the opera- 
tion. On June 8 circulatory depression manifest- 
ed, and Dr. Nix suggested blood transfusion; this 
was given with the result of marked improve- 
ment. On June 12 patient was brighter, aphasia 
less, and on June 13 it had entirely disappeared. 
The rubber dam tube continued to drain and the 
sac grew smaller each day. 

The patient is presented to you tonight with 
normal temperature and pulse; the drain has 
been removed; and v(e believe him entirely cured. 

This ease was discussed by Drs. Anderson and 
Jules Dupuy. 

2. Dr. D. N. Silverman gave a resume of the 
papers read at the recent meeting of the Ameri- 
can Gastro-Enterological Association held at At- 
lantic City. This was presented briefly as follows : 

A case of hypoglycemia by Dr. George Mizell 
of Atlanta — a not unusual condition. Patients 
complain of weakness, sweating, hunger and rapid 
pulse; it is supposedly characteristic of individuals 
in the South, because not enough attention is 
given to the ratio of carbohydrates to fats in the 
diet. Protein consumption is high. Glucose tol- 
erance tests give low readings after administra- 
tion of glucose. The condition is corrected by a 
change of diet. 

Next was a study of gastric acidity in some 
2500 cases of men, women and children by Dr. 
Frances Vanzant of Rochester, Minn. She found 


an absence of hydrochloric acid in 4 per cent of 
the child cases, 20 per cent between the ages of 
20 to 45, and 36 per cent in the older individuals. 
This seems to indicate that if there is plenty of 
hydrochloric acid, you may live to an old age. 

Dr. Ernest Gaither of Baltimore explained the 
recent trend toward the use of histamine in the 
study of gastric secretions; he concluded that his- 
tamine is the best preparation for the determina- 
tion of diagnosis. His research covered one hun- 
dred cases. 

The effect of coffee upon digestion was discussed 
by Drs. Killian and Shattuck of New York. They 
studied the different ingredients of coffee, and 
declared that volatile oils have a detrimental effect 
in producing excessive acid, and that stale coffee 
is far worse than fresh. 

We all know what a vital condition is Addison’s 
disease. This was discussed by Drs. Aaron and 
Hartman of Buffalo. They stated that a patient 
can be kept alive several months by subcutaneous 
injection of adrenal cortex, and that, as indicated 
by their research, a deficiency of adrenal cortex 
is an important factor in this disease. 

Dr. Clement Jones of Pittsburg presented a 
case of acute hemorrhagic pancreatitis. He oper- 
ated, by opening and draining the abdominal cav- 
ity, within two hours after the onset. Patient 
was discharged well after a convalescence of 
eight weeks. 

The most interesting feature of the meeting 
were experiments presented by the famous Pro- 
fessor Walter B. Cannon of Harvard on the study 
of smooth muscles. He found that exposure to 
cold, as well as exertion, produced rapid heart 
action, and the liberation of adrenalin. Some 
of the animals tested were sympathectomized, and 
reacted in the same way. Other results present- 
ed were: That he was able to remove the entire 
sympathetic nervous system and the animals ran 
about perfectly normal; but by removing half the 
sypathetic nervous system, certain smooth muscles 
would go into action and other would not, in the 
particular region where the sypathetic system was 
not removed. He also found that the female 
could reproduce but the male could not, after 
the removal of the sympathetic system. 

On the second day, Dr. Truman G. Schnabel 
of Philadelphia discussed cases of acute abdominal 
pain similar to tabes, due to sickle-cell anemia, 
which have all the appearance of being due to a 
condition requiring surgery. 

Drs. Jordan and Kiefer of Boston reviewed 800 
cases of medical treatment for peptic ulcer. They 
found that in the duodenal ulcers, there were 9 
per cent recurrences in the first year, 46 per cent 
after five years, and 15 per cent hemorrhage. 


60 


Hospital Staff Transactions 


Drs. Mateer and Baltz of Detroit studied the 
condition that is always with us and so annoying 
— spastic colon. They came to the conclusion 
that this is due to micro-organisms. Vaccine 
therapy was used, employing vaccines to which the 
patients showed skin hypersensitivity. The prob- 
lem is presented as to whether one is dealing with 
results of specific vaccine treatment or with non- 
specific protein therapy. 

Drs. Eusterman and Kirklin of Rochester, Minn, 
presented gastric lesions, and made a plea for 
more co-operation between the clinician and the 
roentgen-ray man for the diagnosis of gastric 
lesion. 

Drs. Bartle, Lyon and Sterner of Philadelphia, 
presented an interesting and instructive paper on 
the* 1 choloretic action of decholin. They found, 
from numerous experiments, that there was some- 
thing in this preparation that produced a stimu- 
lation on the part of the liver. 

The last paper was presented by the well known 
Dr. Marx Einhorn, who is nearly seventy years 
of age. He showed the manner of differentiating, 
by means of the roentgen-ray, between the lesions 
in the gastro-intestinal tract and in the kidney, 
through the use of various dyes. These prepara- 
tions are of prime importance for the diagnosis 
and treatment of digestive disturbances. 

Dr. Daniel J. Murphy presented a paper en- 
titled “Interesting Aspects of Rectal Traumatism,” 
in which he gave the classifications of rectal 
wounds and injuries and also included a brief 
resume of the status of foreign bodies in the 
rectum. His paper brought out the importance 
of the integrity of the peritoneum in all rectal 
injuries, for just as soon as the peritoneal cavity 
is opened the injury becomes a very serious one 
and the need for surgical intervention is great 
while the out-look is doubtful but grave. 

If by chance the bladder is also injured along 
with the rectum there is a serious complication 
because of the urinary infiltration which pro- 
duces a rapidly spreading necrosis. 

He described a type of rectal injury that is 
increasing in frequency especially in the indus- 
trial centers that is caused by the introduction 
of compressed air into the rectum. It is well 
understood that the slight distention of the rec- 
tum and colon with air is a great diagnostic aid 
in a number of cases, but when too much air is 
inserted the dangers of over distention and rup- 
ture are apparent. Pneumatic rupture of the 
rectum most frequently occurs as the result of 
hazing or initiating a new employee. In about 
95 per cent of these cases the unfortunate one 
is bent over and while in this posture the com- 


pressed air is turned on, passes through a small 
nozzle with a pressure ranging from 40 to 125 
pounds. The nozzle is placed at or near the anus 
and the air forcefully enters the anus and rectum 
with the possibility of a rupture of the rectum, 
sigmoid, colon or small intestins. This is usually 
followed by an out-cry of pain, fainting or col- 
lapse. In these cases the rupture occurs chiefly 
at the sigmoid flexure. 

He pointed out the fact that bleeding is en- 
countered in rectal injuries but as a rule primary 
hemorrhage is not present to a serious degree yet 
secondary hemorrhage is one of the serious com- 
plications of most rectal injuries. 

The symptoms of an anorectal injury varies with 
the extent, character and location of the wound, 
the time elapsed between when it was made and 
operation and whether or not the wound drains 
freely. 

All traumatic lesions of the upper rectum are 
more serious than those of the more distal por- 
tion because they are more frequently compli- 
cated by infection, abscess and peritonitis. 

Contused and lacerated wounds cause danger- 
ous manifestations less frequently than the deep 
punctured wounds because they are larger, more 
superfinal and drain better. 

Diagnosis: This is comparatively easy when a 
history has been taken, the manner in which the 
accident occurred, and noting the external evi- 
dences of trauma, the bruising, the swelling and 
laceration of the perianal skin or the abdomen. 
A digital or proctoscopic examination will reveal 
to a great extent the envolvement of the rectum. 

He mentioned also an aid in diagnosis that had 
come to his attention through the kindly sugges- 
tion of Dr. J. A. Danna. In cases of perforation 
into the peritoneal cavity there will be produced 
an accidental pneumo-peritoneum which can be 
shown by the use of the roentgen-ray. This aid 
was of diagnostic value in a case which will be 
reported tonight. 

Treatment: This may be simple or complicated 
depending on the type of injury, but under all 
circumstances the wound must be immediately 
cleansed and the bleeding arrested so that the 
character of the injury may be determined. In 
clean incised wounds the injury is closed with 
suture, but whenever there is a contused, lacerated 
or pneumatic injury institute sufficient drainage 
at once. Wherever there is an abdominal perfora- 
tion an exploratory operation must be made. 
When the abdomen is opened one can easily as- 
certain the real damage done and perform such 
corrective measures as will fit the individual case. 


Orleans Parish Medical Society 


61 


A life saving - proceedure in a vast majority of 
these cases of rectal perforation is the operative 
proceedure of making a temporary artificial anus 
through a left colostomy which permits the evac- 
uation of feces without disturbing the rectum and 
anus, which need complete rest at this time for 
an early and uneventful healing. 

He presented two cases, one was in a man 
forty-six years of age who complained of rectal 
bleeding without any other sign or symptom for 
over one month. He was treated by other phy- 
sicians for hemorrhoids, but a proctoscopic exam- 
ination revealed the presence of a dental bridge 
that was caught by its hook like projection to the 
anterior rectal valve. It was removed very easily. 
In going back on the history the patient reported 
that he must have accidentally and unknowingly 
swalolwed his plate four months before. His bleed- 
ing started on a drinking bout. 


The second case was that of perforation of the 
rectum and sigmoid by an iron picket. In this 
case a left colostomy was performed together 
with very free drainage, of the wound at entrance. 
At the present time this patient, a child of ten 
years is absolutely cured of his rectal injuries and 
also his colostomy opening. 

This paper was discussed by Drs. J. A. Danna, 
M. J. Gelpi and Jerome Landry. 

There was the discussion of a case of Dr. Louis 
Levy on which an autopsy had been performed, 
autopsy diagnosis being as follows: Chronic pas- 
sive congestion and cirrhosis of the liver; chronic 
diffuse nephritis; myocarditis; edema of the lungs. 
Dr. Maurice J. Couret and Dr. J. A. Danna, as 
well as Dr. Levy, contributed to this discussion. 

The meeting closed with the statistical report 
and routine business of the staff. Adjournment 
was until October, 1931. 


TRANSACTIONS OF ORLEANS PARISH MEDICAL SOCIETY 


During the month of June the Society held two 
scientific meetings. 

At the meeting held June 8 the program was 
as follows: 

The Rabbit Ovulation Test in the Diagnosis of 
Pregnancy. 

By: Drs. E. L. King and John A. Lanford. 

Discussed by Dr. Hilliard E. Miller. 

The Predisposing Cause of Pulmonary Tubercu- 
losis from the Standpoint of Endocrinology. 

By: Dr. Emile A. Bertucci 

Discussed by Dr. Rigney D’Aunoy. 

The Etiology and Prognosis of Sinusitis. 

By: Dr. John B. Gooch 

Discussed by Dr. J. R. Hume. 

The meeting of June 22 was voted by the Board 
of Directors to be called the Frederick Loeber 
Memorial night in honor of Dr. Frederick Loeber, 
one of the Founders of the Orleans Parish Medi- 
cal Society. The program was as follows: 

Dr. Frederick Loeber, 1839-1901. 


By:. Dr. A. E. Fossier. 

Memories of Dr. Loeber. 

By: Dr. Otto Joachim. 

Scientific Presentations. 

Chaulmoogra Oil in the Treatment of Arthritis. 
By: Dr. Paul A. Mcllhenny. 


Discussed by Dr. E. D. Fenner. 

An Example of What Surgery Can Do in Saving a 
Certain Group of Cases of Pulmonary Tubercu- 
losis, as Illustrated by a Case Report. 

By: Dr. Joseph A. Danna. 

Discussed by Drs. Alton Ochsner and 
Shirley C. Lyons. 

The attendance at both meetings was very good. 


It was with a great deal of satisfaction and 
pleasure that we learned that New Orleans had 
been selected for the 1932 convention of the 
American Medical Association. A majority vote 
of 58 over Memphis and San Francisco gave us 
the meeting. The invitations of the Orleans Par- 
ish Medical Society and the Louisiana State Medi- 
cal Society were extended last year. We wish to 
express our gratitude to our Delegates for their 
co-operation in this matter. The Association of 
Commerce also assisted materially in getting this 
meeting for us, and we appreciate their efforts. 


During the months of July, August and Septem- 
ber the Society will adjourn for its annual vaca- 
tion. The second quartely executive meeting to 
be held July 13 will be the last meeting before 
adjournment. 


The third quarterly installment on the group 
insurance premium must be paid July 5. Please 
send in your check by July 1 in order that we may 
get our check to the home office on the due date. 


62 


Orleans Parish Medical Society 


The various committees appointed for the en- 
tertainment of the coming meeting of the South- 
ern Medical Association to be held here in Novem- 
ber have been busy during the past month. 


The membership of the Society to date is 505 
of whom 479 are active members. 


TREASURER’S REPORT. 


Actual Book Balance April 30, 1931 $1,038.40 

Receipts 1,592.47 

$2,630.87 

Expenditures 832.38 

Actual Book Balance May 31, 1931 $1,798.49 


LIBRARIAN’S REPORT. 

One hundred and twenty-three books have been 
added to the Library during May. Of these 10 
were received from the New Orleans Medical and 
Surgical Journal, 52 by gift, 3 by purchase and 
56 by binding. New titles of recent date are 
listed herewith. 

The Convention of the Medical Library Associa- 
tion has come and gone, and from all reports 
the meeting w^as most successful and enjoyable. 
Forty-two persons attended the sessions from 28 
medical libraries. The institutions represented 
are listed on the attached sheet — showing the 
breadth of interest in medical libraries, in our 
meetings. The following resolutions of apprecia- 
tion -was exterded to the Medical Society and the 
Medical School as hosts: 

“It is always with regret that we come to the 
end of our meetings. Before we go our various 
ways, we v ish to express to our hosts and host- 
esses of the past three days, the sincere apprecia- 
tion of the Association for the perfectly wonderful 
time we have ail hsd in New Orleans. 

“We wish to thank the Orleans Parish Medical 
Society and the Tu’ane University School of Medi- 
cine, the ladies who so graciously entertained us, 
and everyone who so hospitably received us into 
their city and their hearts. 

“We have had a wonderful time and wish to 
say thank you by rising in a body to express our 
appreciation of the nicest meeting we have 
ever had.” 

The Association will be the guest of the Lane 
Medical Library of Leland Stanford University, 
San Francisco, next year. 

NEW BOOKS. 

Ashhurst — Surgery, its Principles and Practice. 
1931. 

Gunn — Introduction to Pharmacology and Ther- 
apeutics. 1931. 


Besredka- — Immunity in Infectious Diseases. 

1930. 

Homans — Textbook of Surgery. 1931. 

Peters — Quantitative Clinical Chemistry. 1931. 
DaCosta — Selections from Papers and Speeches. 

1931. 

Sachs — Diagnosis and Treatment of Brain 
Tumors. 1931. 

Sinclair — Microbiology and Elementary Pathol- 
ogy. 1931. 

Hawes — Talks on Tuberculosis. 1931. 
Blanchard — Letters of Dr. Betterman. 1931. 
American Laryngological, Rhinological and Ot- 
ological Society Transactions. 1930. 

Stahl — Concerning the Earliest Growth in the 
Human. 1931. 

Dickson — Posture, its Relation to Health. 1931. 
Barker — Backache. 1931. 


LIBRARIES REPRESENTED AT THE NEW 
ORLEANS MEETING OF THE MEDICAL 
LIBRARY ASSOCIATION MAY 19-21, 1931. 

Michigan University Department of Medicine 
Library. 

Orleans Parish Medical Society Library. 

Tulane University School of Medicine Library. 
Michigan University Department of Dentistry 
Library. 

Columbia University College of Physicians and 
Surgeons Library. 

Kansas University School of Medicine Library. 
U. S. Naval Medical Library (Washington, 
D. C.) 

Cornell Medical Library. 

Guthrie Clinic (Sayre, Pa.) 

Cleveland Medical Library Association. 

Illinois University School of Medicine Library. 
Vanderbilt University School of Medicine Li- 
brary. 

Chicago University School of Medicine Library. 
Houston Academy of Medicine Library. 

Medical and Chirurgical Faculty of Maryland. 
Emory University — A. W. Calhoun Library. 
Medical Department — Detroit Public Library. 
Jackson Co. Medical Society Library. 
Washington University School of Medicine Li- 
brary. 

St. Louis Medical Society Library. 

Texas University School of Medicine Library. 
Ramsay Co. Medical Society Library. (St. Paul). 
Duke University Medical Department Library. 
St. Louis University School of Medicine Li- 
brary. 

Baylor Unversity School of Medicine Library. 
New York Academy of Medicine Library. 
Arkansas University School of Medicine Library. 
Hotel Dieu Library. 

H. Theodore Simon, M. D., Secretary. 


LOUISIANA STATE MEDICAL SOCIETY NEWS 

H. Theodore Simon, M. D., Associate Editor. 


FROM OUR PRESIDENT. 

MEDICAL ORGANIZATION AND MEDICAL 
ECONOMICS. 

According to precedent and custom, the Presi- 
dent of the State Medical Society is expected to 
function as best he can during his tenure of office, 
to study and act upon problems as they arise dur- 
ing his administration, and at the next annual 
meeting give a report to the House of Delegates 
on his activities, recommending for their con- 
sideration, matters of special importance to the 
whole society. 

Since the office of President-elect was created, 
giving to the individual chosen to fill this position, 
a full year to inform himself on matters of im- 
portance to the association, it would seem to the 
writer that a slight at least, readjustment of the 
program and scheme would be in order. It would 
appeal to us as logical, more practical and promis- 
ing of better results, were the incoming President 
of the association, after a years study of the situa- 
tion, to give to the membership and officers of the 
inauguration, his ideas of the main problems that 
press for solution: the ones that he expects to 
center his energies upon: the one that he will seek 
their aid in solving during the coming year. 

New problems will arise, old ones will continue 
to plague us, and regardless of the effort put 
forth, there will always be much left over for solu- 
tion and passed on to our successors. However, 
with some definite scheme in mind known to all, a 
more coordinated effort must result, and the ac- 
complishment at the end is bound to be greater. 

With this idea in mind, I am seeking through 
the columns of the official Journal, at least a 
mental contact with every officer of the associa- 
tion, the component associations and every legally 
qualified physician in the state. 

As I view the situation at this time, there are 
two outstanding needs of organized medicine in 
Louisiana, and my whole effort this year will be 
directed towards centering the attention of the 
profession on this solution. 

First and foremost, a perfected organization 
with a large majority of the legally qualified 
doctors of the state is essential, as -is the case in 
every organization. With a membership of little 
over half of the eligible men in the Association, 
we must admit that something is wrong. 

For fifty-two years we have tried to build up 1 
the state organization by interest in the Parish 
Society. In such a large majority of the Parishes, 


the membership is so small, it is impossible to 
maintain interest. 

In the District Societies, I believe we have the 
solution. In some districts more frequent meet- 
ings than in the past. I feel confident will get 
the interest aroused of many whom we have failed 
so far to win over. In those districts that have 
been having frequent and regular meetings, but 
few doctors are found not members of the State 
Society. 

Without organization, nothing can be accom- 
plished; with it, any program we might sponsor 
will go over, and any evil we combat will go down 
in defeat. 

To the District Societies, I made my appeal for 
a united effort. Give the men who have not an 
active Parish association, an opportunity and our 
membership will grow. 

With a perfected, thorough organization of the 
doctors of the state, functioning smoothly, what 
problem should they face and press for solution 
as the most urgent need? Some will be quick to 
suggest certain scientific questions. I would say 
no. We need have no fear for the further and 
constant development of scientific medicine, so 
long as the medical profession is unhampered and 
permitted to run its business as the profession, 
and the profession only, knows it should be run. 

The medical economic trend to our mind, looms 
as the dark cloud on our horizon and must be 
faced with clear judgment and firm decision 
rather than with timidity and a fear of criticism. 
Those who are willing to lie down, who are afraid 
to stand out and preach what they know is right 
and even suggest what the assassins of the prin- 
ciples of American Medicine would manacle us 
with, have no place in our program. 

In a recent editorial appearing in the Journal 
of the American Medical Association, the editor 
criticised in no uncertain language, the little 
periodical known to us as “Medical Economics,” 
for discussing so freely and often with doctors, the 
question of finances, and winds up by stating that 
only by living up to tradition and past teachings, 
can medicine continue to advance. 

What other undertakings of man today, are ad- 
vancing by living wholly in the past? And where 
comes in the evil of discussing finances? The 
Great Teacher of Man discussed money in many 
of his parables and in none did he teach other 
than the love of money was a sin. Times are 
changing and with or without our will, we must 
change with them. 


64 


Louisiana State Medical Society 


Creeping in from all sides, insiduously and 
relentlessly, the doctor’s source of income is being, 
trimmed while we sit supinely by, living upon 
tradition. That time honored and sacred rela- 
tionship existing between the doctor and patient 
by which their professional and business arrange- 
ments are mutually satisfactoi*y, must not be dis- 
turbed. 

However, the state, the public and each commu- 
nity must come to know that the care of the in- 
digent sick is a state and community prob- 
lem to be met by the whole community and 
must not be shunted to the shoulders of an in- 
dividual group (doctors) of citizens. When an 
indigent is to fed, organized charities do not call 
upon the retail merchants association to feed him, 
but if he is sick, though contributing to all the de- 
mands of society, the doctor is supposed to donate 
his only commodity, medical service. This is 
fundamentally, economically, logically, morally 
and in every way, wrong, though in line with what 
some would call tradition. 

Medicine has advanced because of some of its 
traditional teachings and in spite of others, she is 
being nailed to the cross today, because she has 
failed to realize that our complex civilization is 
forcing a readjustment of all human activities. 
Unless medicine, as an organization, realizes that 
evolution has worked and is still working changes 
in the midst of which no activities of man can 
stand still, she will soon deserve and meet face to 
face, controlling influences from without, which 
will shatter every tradition and render impotent 
for all time her influence in directing her own 
destiny. 

The practice of our profession is our business, 
and deep in the hearts of every doctor, he knows 
this statement is true. He who is afraid of 
criticism when he knows he is right, can hardly be 
termed a man. 

The State, District and Parish Societies should 
each have a virile active committee whose duty it 
would be, to educate, coordinate and direct lay and 
state medical activities into channels best suited 
for public good, and at the same time, tactfully 
and diplomatically, but positively, stand for the 
principle that no state, state department, subdivi- 
sion of the state, or organization within the state, 
have a right to draft our services simply because 
it has been permitted and condoned in the past. 
The state and no subdivision of the state has a 
right to practice other than preventive medicine, 
save among those who are indigent and others 
under restraint. 

When the profession learns to be a little more 
deliberate in running up the flag “no charge,” in 
matters of medical service where the whole com- 


munity, the state or its subdivisions owe the obliga- ; 
tion, the problem will be easier of solution. 

The medical trend can be changed, but thorough 
organization and co-ordinated effort are essential 
and the frank demand on the part of the doctor 
for a right to a square deal, a fair wage and in- 
surance against old age. 

S. C. Barrow, M. D., 

President, Louisiana State Medical Society. 


CHAIRMEN OF SECTIONS. 

The following Chairmen of Scientific Sections 
for the approaching meeting of the Louisiana 
State Medical Society, Lake Charles, April 12, 13, 
and 14, 1932, have been appointed by the Presi- 
dent: 

Medicine and Therapeutics — Dr. Thos. P. Lloyd, 
Shreveport. 

Pediatrics — Dr. J. A. Crawford, Lake Charles. 

Nervous Diseases — Dr. F. F. Young, Covington. 

Bacteriology and Pathology — Dr. F. M. Johns, 
New Orleans. 

Publiic Health and Sanitation — Dr. J. A. O’Hara, 
New Orleans. 

Gastro-Enterology — Dr. C. M. Horton, Frank- 
lin. 

General Surgery — Dr. E. L. Sanderson, Shreve- 
port. 

Gynecology and Obstetrics — Dr. J. T. Cappel, 
Alexandria. 

Eye, Ear, Nose and Thoat — Dr. Jules E. Dupuy, 
New Orleans. 

Urology — Dr. B. McE. McKoin, Monroe. 

Radiology — Dr. G. C. McKinney, Lake Charles. 

Orthopedic Surgery — Dr. C. A. Lorio, Baton 
Rouge. 

Those desirous of reading papers should com- 
municate with the various Chairmen as promptly 
as possible. The program for each Section must 
be in the hands of the Secretary-Treasurer not 
later than Feburary 12, 1932. 


BI-PARISH MEDICAL SOCIETY. 

The East and West Feliciana Bi-Parish Medical 
Society met in the East Louisiana State Hospital. 
After an elaborate banquet, the scientific program 
consisted of a paper by Dr. W. K. Irwin on Blood 
Transfusion. The paper was discussed by Dr. U. 
S. Hargrove. Dr. W. C. Norris real a paper on 
“Dental Sepsis the Cause of Maxilary Sinusitis,” 


Louisiana State Medical Society 


65 


which was discussed by Dr. E. M. Robards. A 
vote of thanks was extended to Drs. Irwin and 
Norris for their presentations of these excellent 
papers, and the able discussions by Drs. Hargrove 
and Robards. 


EIGHTH DISTRICT MEDICAL SOCIETY. 

On June 1, 1931, a meeting of the physicians 
of the Eighth Congressional District of Louisiana 
was called to order by Dr. J. H. Landrum of 
Alexandria, La., councillor for the district. The 
purpose of this meeting was the reorganization of 
the Eighth District Medical Society. 

The following officers were elected unani- 
mously : 

Dr. W. G. Allen of Converse, La., (Sabine 
Parish ) — President. 

Dr. Carson R. Reed, of Natchitoches, La., 
(Natchitoches Parish) — First Vice-President. 

Dr. R. G. Ducote of Bordelonville, La., (Avoy- 
elles Parish) — Second Vice-President. 

Dr. J. H. Landrum of Alexandria, La., (Rapides 
Parish) — Secretary-Treasurer. 

Dr. S. J. Couvillon of Moreauville, La., (Avoy- 
elles Parish) — Delegate to Louisiana State Med- 
ical Society. 

Following the above the regular monthly meet- 
ing of the Rapides Parish Medical Society was 
held. A paper on “Errors in Calcium Metabolism” 
was read by Dr. King Rand, and one by Dr. B. H. 
Texada on “Syphilis of the Lungs with Report of 
a Case.” This was followed by a motion pic- 
ture on “Rehabilitation after Fractures.” 

E. Weiner, M. D., 

Sec.-Treas., Rapides Parish Medical Society; 

J. H. Landrum, M. D., 
Sec.-Treas., Eighth Dist. Medical Society. 


NEWS ITEMS. 

The following men from Louisiana appeared on 
the program of the American Medical Association 
in Philadelphia, Pa., the first week in June. 

Clinical Lecture — Deficiency Diseases: Clinical 
Recognition and Management, Dr. John H. Musser. 

A Physiologic Basis for the Treatment of 
Pellagra was presented by Dr. R. H. Turner. 

Dr. Charles A. Bahn discussed a paper and also 
Dr. D. C. Browne. 

A paper on Acute Suppurative Conditions of 
the Hip Joint, was read by Dr. Guy A. Caldwell, 
Shreveport, La., before the Section on Orthopedic 
Surgery. 


Dr. Charles J. Bloom, Professor of Pediatrics 
with the Graduate School of Medicine of The Tu- 
lane University of Louisiana, addressed the St. 
Tammany Parish Medical Society, at Slidell, La., 
on Friday, June 12, 1931, on “Intestinal Disturb- 
ances in Infants and Children.” 


Dr. Henry Daspit, Dean of the Graduate School 
of Medicine, will attend the Congress of the Pan- 
American Medical Association in Mexico City, 
July 12. 


Dr. Aristides Agramonte, Professor of Tropical 
Medicine in the Louisiana State University Med- 
ical School, will attend the Congress as a delegate 
from the New Orleans Chapter. 


TANGIPAHOA PARISH MEDICAL SOCIETY. 

Another great meeting of the Tangipahoa 
Parish Medical Society was held at City Hall, 
Hammond, May 14. Some twenty odd doctors 
present with a program as before mentioned “from 
brain surgery to scabies.” 

Guests adding to the interest of the program 
were Dr. G. C. Anderson, of New Orleans, sub- 
ject: “Brain injuries.” Dr. T. B. Sellers, of the 
Southern Baptist Hospital, New Orleans, “Office 
management of gynecological patients,” and Dr. 
E. M. Robards, East Louisiana State Hospital, 
Jackson, “Early laboratory manifestations of pul- 
monary tuberculosis.” 

One of the most pleasing features of the even- 
ing was a bounteous spread with plenty to eat. 

A joint meeting of the Tangipahoa, St. Tam- 
many and Livingston is proposed for our July 
Ponchatoula meeting. 

W. T. Newman, M. D., 

Secretary. 


ST. TAMMANY PARISH MEDICAL SOCIETY. 

The St. Tammany Parish Medical Society met in 
the Community Room, Bank of Slidell, Slidell, La., 
on June 12, 1931, at 8:00 p. m., with thte follow- 
ing members present: Dr. J. K. Griffith, Presi- 

dent, Dr. J. R. Singleton, Dr. H. D. Bulloch, 
Dr. H. E. Gautreux, and Dr. J. F. Polk, Secretary. 
The minutes of our last meeting were adopted as 
read. The Society was honored with the presence 
of Drs. Chas. J. Bloom and J. E. Strange from 
New Orleans. Dr. Bloom, by invitation, presented 
us with an address of his own choosing, “Append- 
icitis in Children.” In his message tthe doctor 
went very minutely in detail as to signs and 
symptoms, including with it rooentgen-ray and 
blood picture. Treatment consisted of the things 
not to do as well as what should be done. The 
Society is indeed very grateful to the doctor for 


66 


Louisiana State Medical Society 


his message, which was very timely. The Society’s 
meeting closed to meet in Covington, La., July 10. 

Jno. K. Griffith, M. D. J. F. Polk, M. D., 
President. Secretary. 


APPROACHING MEETINGS. 

At the International Colonial Exposition, which 
will be held in Paris this coming summer, July 22- 
31 have been set aside by the authorities as Colo- 
nial Medical Days. During this period of time an 
attractive program will be presented for the pur- 
pose of showing what France has accomplished 
from the point of view of sanitation for her 
colonies and her possessions over sea. A dis- 
tinguished list of French doctors will participate 
in this celebration. 


THE AMERICAN COLLEGE OF PHYSICIANS. 

The American College of Physicians will hold its 
Sixteenth Annual Clinical Session at San Fran- 
cisco with headquarters at the Palace Hotel, April 
4-8, 1932. Following the Clinical Session, a large 
percentage of the attendants will proceed to Los 
Angeles where a program principally of entertain- 
ment will be furnished April 9, 10 and 11. 

Announcement of the dates is made particularly 
with a view not only of apprising physicians gen- 
erally of the meeting, but also to prevent conflict- 
ing dates with other societies that are now ar- 
ranging their 1932 meetings. 


INTERNATIONAL CONGRESS OF 
COMPARATIVE PATHOLOGY. 

The Second International Congress of Compara- 
tive Pathology will be held at the Colonial Ex- 
position, Paris, October 14-18, 1931. 


CANCER COMMISSION OF THE CALIFORNIA 
MEDICAL ASSOCIATION. 

The Californial State Medical Association has 
appointed a Cancer Commission for the purpose 
of representing the Association in all phases of 
the organized fight upon the increasing menace of 
this disease. As its first objective, the Commis- 
sion plans to review and to bring widely to the at- 
tention of the profession in the State the most 
modern methods of diagnosis and treatment, 
especially of early carcinoma. Subsequent efforts 
will be directed toward education of the lay public, 
as well as the establishing of specially equipped 
clinics. The Commission as organized has for its 
Chairman, Dr. Charles A. Dukes, Vice-Chairman, 
Dr. L. C. Kinney, and Secretary, Dr. A. R. Kilgore. 


GIFT OF DR. EWING. 

Dr. Fayette C. Ewing of Alexandria has pre- 
sented to the Tulane University School of Medi- 
cine a magnificent collection of old prints on the 


healing art. Dr. Ewing has been collecting these 
old prints for a great many years. The collection 
contains forty-three pictures and three interesting 
pieces of sculpture. The whole collection made a 
magnificent addition to the Historical Room of the 
Library of the Tulane Medical School, which Dr. 
Rudolph Matas was instrumental in founding and 
who has a tremendous interest in the progress of 
the room. 

Dr. Ewing is a graduate of Jefferson Medical 
College of the class of 1884. He has been now 
for some years a member of the Rapides Parish 
Medical Society living in Alexandria. 


HEALTH OF NEW ORLEANS. 

The Division of Vital Statistics reported for the 
week ending May 30 that there were 127 deaths 
in the City of New Orleans, giving a rate of 14.2. 
Eighty-three of these deaths were in the white 
and 44 in the colored population. The infant 
mortality rate for this week was 18 for white and 
81 for colored infants. The following week, June 6, 
showed a death rate of 17.2, as a result of 154 
deaths in the City, 83 of whom were white and 71 
colored. The very remarkable low infant morality 
rate for white infants had jumped up to 74 and 
the negro rate to 114 in this particular week. 

During the week ending June 13, there were 
139 deaths in New Orleans, giving a death rate of 
15.5. The infant mortality rate was 88, 74 in white 
children and 114 in the colored. 


INFECTIOUS DISEASES IN LOUISIANA. 

The Treasury Department of the United States 
Public Health Service, in collaboration with Dr. 
J. A. O’Hara, has published the following report 
on infectious diseases in Louisiana. For the week 
ending May 23, there were reported 63 cases of 
pneumonia, 35 of tuberculosis of the lung, 11 of 
influenza, 7 cases of typhoid fever, 38 of syphilis, 
and 13 of gonorrhea, and among the less frequent 
of important contagious diseases 12 cases of small 
pox, 19 of diphtheria, 2 of meningitis, and 21 of 
scarlet fever. Nine of these cases of small pox 
occurred in the City of New Orleans, and 18 of 
the cases of diphtheria. For the week ending May 
30, pneumonia was again the leader in the re- 
portable diseases, 73 cases occurring in the State 
in this particular week. There were also re- 
ported 37 cases of pellegra, 3 of syphilis, and 5 
of gonorrhea. Nineteen cases of small pox were 
reported, 10 of these occurring in Bienville Parish. 
There were also reported 3 cases of undulant 
fever and 3 cases of poliomyelitis. For the week 
ending June 6, pneumonia had increased to 97 
cases reported in this month. There were only 
12 cases of influenza and the same number of 
cases of typhoid fever. Fifty-two cases of syphilis 
were reported and 28 of gonorrhea. The small 


Louisiana State Medical Society 


67 


pox incidence in the State had increased, 27 cases 
being reported, 13 of which came from Bienville 
Parish and 5 from Orleans. There was only one 
case of meningitis reported this week, and one 
case of undulant fever. Forty-one cases of pel- 
legra were reported this week, and for the week 
ending June 13, 69 cases of this extremely pre- 
valent disease occurred in the State of Louisiana, 
leading all other reportable diseases. The pneu- 
monia incidence had fallen to 26, but typhoid 
fever had increased to 17 cases and scarlet fever 
to 24, 15 of the cases coming from Orleans Parish. 
Of the 17 cases of small pox, Orleans and St. 
Johns Parishes each reported 5, the remaining 
cases being scattered all over the State. Two 
cases of meningitis and one of poliomyelitis were 
likewise reported this week. 


SAMUEL M. LYONS, M. D. 

The many friends of Dr. Samuel M. Lyons of 
Sulphur will be greatly distressed to hear of his 
death, which occurred on June 19 after a stroke 
of apoplexy two weeks previous. Dr. Lyons was 
one of the active members of the Louisiana State 
Medical Society. Not only was he interested in 
his profession, but he also took a very lively part 
in political and social life of his community. At 
various times he served as a member of the Police 
Jury, as a Tax Assessor, and as Coroner. At the 
time of his death he was a member of the Louisi- 
ana House of Representatives. 

Of Dr. Lyons’ four sons, three of them are 
physicians. Two of these three, Dr. Shirley C. 
Lyons and Dr. Kyle M. Lyons, are practicing in 
New Orleans. 


ROBERT G. HAWKINS, M. D. 

The St. Landry Parish Medical Society informs 
us of the death of Dr. Robert Garnett Hawkins, 
of Palmetto, St. Landry Parish, La. Dr. Hawkins 
was regarded as a leading general practitioner in 
his section, and was also highly esteemed as one 
who exerted every effort towards the civic better- 
ment of his community. For many years he was 
a valued member of the St. Landry Parish Medical 
Society. The doctor was born at Waxia La., on 
October 24, 1863, and died at Opelousas, La., on 
June 17, 1931. He was a member of Humble Cot- 
tage Lodge, No. 19, F. & A. M., of Opelousas, La., 
and also a member of Palmetto Camp, Woodmen 
of the World. Surviving the doctor are his wife 
and the following children: Miles Hawkins, 

Mrs. J. A. Niel, Mrs. A. J. Garon, Floyd Hawkins, 
Aubrey Hawkins, and Mrs. J. A. Roulet. 


WOMAN’S AUXILIARY NOTES. 

The regular meeting of the Woman’s Auxiliary 
to the Ouchita Parish Medical Society was held 
Wednesday morning, at the residence of Mrs. B. 
M. McKoin, Mrs. J. B. Vaughan, president, pre- 
siding. Twenty members were present. 

Reports from the State Convention, held re- 
cently in New Orleans, were made by Mrs. J. P. 
Brown and Mrs. P. L. Perot. 

Plans were perfected at this time for a tea to 
be given Friday afternoon at the residence of Mrs. 
McKoin, honoring the graduating class of the St. 
Francis Sanitarium School for Nurses. 

Mrs. E. R. Yancey, 
Publicity Secretary. 


The following annual report of The Woman’s 
Auxiliary to the Orleans Parish Medical Society, 
was thought of such interest that it is published 
intact. This was written and presented by their 
President, Mrs. J. Ambrose Storck. 

ANNUAL REPORT OF THE WOMAN’S 
AUXILIARY TO THE ORLEANS 
PARISH MEDICAL SOCIETY. 

To the officers and members of the Auxiliary, I 
desire herewith to submit my report for the sea- 
son 1930 to 1931, October to May, inclusive. The 
second year of the Auxiliary has been marked by 
steady growth and definite accomplishment. The 
organization now has two hundred and sixty-seven 
members. The attendance at each of eight regular 
meetings has been a large majority of the total 
number, showing that keen interest has been main- 
tained. Work has progressed along the three lines 
of endeavor in our general program — social, 
philanthropic and educational. The several chair- 
men, Mrs. John H. Musser of the social group; 
Mrs. W. R. Buffington of the philanthropic group; 
and Mrs. Ludo von Meysenbug of the educational 
group have all functioned with interest and en- 
thusiasm. The entertainment committee, com- 
posed of Mrs. Homer Dupuy and Mrs. Thomas 
Walshe secured places of meeting, and provided 
vocal and instrumental programs by talented local 
artists. The spacious homes opened to the auxili- 
ary were those of Mrs. John Smythe, Mrs. John T, 
Nix, Mrs, Isadore Cohn and Mrs. George Dempsey, 
where the generous hospitality of the hostess and 
her co-hostesses infused a spirit of comradeship 
and good will throughout the gathering. First and 
last meetings at the Orleans Club; another meet- 
ing here with Mrs. Arthur Whitemire, hostess, and 
a large group of the younger element as co- 
hostesses; and the April meeting and reception at 
the New Orleans Country Club, with Mrs. Joseph 
Hume, hostesses, and members of the entertain- 


68 


Louisiana State Medical Society 


ment committee as joint hostesses, sums up the 
places of our assemblies. 

In addition to its regular work along social lines, 
the auxiliary has helped its affiliated organization 
on two occasions — the entertainment incident to 
the installation of new officers of the Parish So- 
ciety, January 5; and entertainment of the wives 
of the doctors attending the Louisiana State Med- 
ical Convention, April 13, 14, and 15. This was 
the first opportunity afforded us for such serv- 
ice in our brief existence, and we were anxious to 
show our willingness and our ability. Mrs. W. H. 
Seeman was in charge of entertainment for the 
meeting in January. Wives of the doctors at- 
tended in greater numbers than at any previous 
installation; and, in all respects, the work of Mrs. 
Seeman and her committee was successful. Mrs. 
Joseph H. Hume was chairman of the woman’s 
entertainment committee for the State Conven- 
tion. Thorough organization, careful working out 
-of detail, and business methods in the handling of 
the generous allowance made by the Parish So- 
ciety, resulted in a delightful round of entertain- 
ments. There was a surplus of funds which was 
returned to the Society. Mrs. Hume has left a 
record of her plans and procedures which will be 
of help to those who may have charge of such 
work in the future. 

The telephone committee under Mrs. Roy B. 
Harrison has done yeoman’s service with a graci- 
ous ease more apparent than real, because it was 
done “con amore.” The membership committee 
under Mrs. S. M. Blackshear has continued to 
work for new members with unabated zeal. Mrs. 
Chaille Jamison, as chairman of the courtesy com- 
mittee, has found both the usual and unusual 
means of showing kindness in times of sickness 
and bereavement as well as on happy occasions. 
The educational group, under Mrs. Ludo von 
Meysenbug, has centered its interest in placing 
Hygeia in the schools. Mrs. Buffington has de- 
veloped the philanthropic work through a very 
active committee to a point where decided prog- 
ress has been made — collection of good used 
clothing for boys and girls of the vocational guid- 
ance department of the New Orleans public 
schools; donation of money for luncheons for 
needy students; and collection of medicines from 
doctor’s offices for use in child welfare clinics 
make a sum total of really worth while work. 


The contact committee between our auxiliary 
and the Orleans Parish Medical Society is com- 
posed of Dr. Edward S. Hatch, chairman, and 
Doctors Randolph Lyons and Ludo von Meysen- 
bug. This is the committee to which the auxiliary 
refers its problems touching the two organizations, 
and whose advice is requested before entering new 
projects. Mrs. Seward Wills has been prompt and 
explicit throughout the year in handling publicity. 
Mrs. Rogers Brewster has shown ready willingness 
to write graceful and tactful letters in her ca- 
pacity as corresponding secretary. Mrs. A. L. 
Levin, as recording secretary, has shown her usual 
devotion to duty. With so little red tape about 
the running of the auxiliary, Mrs. Arthur Weber 
has had little occasion to use her able judgment 
in parliamentary ruling. Mrs. Randolph Lyons 
has officiated as treasurer with painstaking ability. 
In sending the pro rata for State and National 
Auxiliary dues, she appended the names and ad- 
dresses of every member who had paid into our 
organization. This is stated merely as an indica- 
tion of her close attention to details. The lecture 
committee, consisting of Mrs. A. J. Babin, Mrs. 
W. P. Gardiner and Mrs. J. A. Storck, were suc- 
cessful in securing a series of informative and de- 
lightful biographical lectures delivered by mem- 
bers of our distinguished medical fraternity. Their 
ready response to our request has been a most 
friendly gesture on the part of our affiliated or- 
ganization, and makes us feel that we not only 
belong to them but that they belong to us. Our 
distinguished speakers were Dr. Maud Loeber on 
“Paracelsus”; Dr. Elizabeth Bass on “Florence 
Nightingale”; Dr. Herman B. Gessner on “Hip- 
pocrates”; and Dr. Philip H. Jones on “Galen”. 

In closing my report, I wish to say as I said in 
my previous annual report, that the Women’s 
Auxiliary to the Orleans Parish Medical Society 
has been well officered. I desire to thank each 
individual who has co-operated so cheerfully and 
ably in the aims and accomplishments of the auxi- 
liary. It has been a rare privilege and a high 
honor to work with, and for, and through such a 
splendid group of women. I wish to thank the 
entire auxiliary with its wonderful personnel for 
its sustained interest and enthusiasm. The auxili- 
ary is rich in available material for any undertak- 
ing which may be attempted. With the continued 
growth of the auxiliary, with the maturity which 
comes with time, and with the broadening of its 


Louisiana State Medical Society 


69 


scope under new leaderships, I feel that the or- 
ganization is destined for wide usefulness in the 
community at large, and that the members are 
most fortunate in their individual relationships to 
each other. I know whereof I speak; for person- 
ally, I have been the recipient of so much friend- 
liness and so much spiritual comfort in a time of 
great mental and emotional stress that I do not 
have words to express my thanks. I do not say 
that it was not difficult to go on during my hus- 
band’s illness, but it would have been impossible 
without your sympathy and support. 

Last year, in my final report, I said that when 
you have told somebody you love them, there is 
nothing more to say. I feel as I did then — bound 
to you by love and friendship. But I wish to 
add just this. In the community of interests 
which draws you closely together; in the good 
feeling which is apparent on all sides ; in the kind- 
liness which finds expression in so many ways, I 
can speak more broadly than before and say, with 
confidence, that ye are carrying out the words of 
the Master: “Love one another”. 


Mrs. Wilkes Knolle, Mrs. Donovan Browne and 
Mrs. W. R. Buffington represented the Woman’s 
Auxiliary of the Orleans Parish Medical Society 
at the American Medical Association held in 
Philadelphia the early part of June. . We un- 
doubtedly will have excellent reports from them 
of the proceedings. 

During the month of May, the American Med- 
ical Library Association was entertained by the 
Assistant Librarian of the Orleans Parish Medical 
Society, Miss Mary Marshall, at a tea at the Petit 
Salon. Several co-hostesses assisted Miss Marshall. 


The Orleans Parish Medical Society has been 
approached by the Registered Nurses Association 
to join in an educational program to introduce 
“Part time nursing” into the various organizations 
and homes. At a business meeting earlier in the 
month, this matter was discussed. It was decided 
that at this particular time the Orleans Parish 
Medical Sociey was not in a position to help, even 
so worthy a cause as “Part time nursing”. 

Marguerite H. Musser, 

State Publicity Chairman. 


THE COMMONWEALTH FUND AND TULANE 
UNIVERSITY. 

Dean Bass, of the School of Medicine, Tulane 
University, announced, just as we were going to 
press, that the Commonwealth Fund was prepared 
to give five scholarships to undergraduate students 
of Mississippi in Tulane University, these scholar- 
ships ultimately to amount to twenty. As further 
aid in the promotion of rural health work in the 
State of Mississippi, fifteen fellowships are to be 
granted to physicians of Mississippi for work in 
the Graduate School of Tulane. In order to im- 
prove instructions in the methods of prevention 
of disease, Tulane will be granted yearly, over a 
period of years, the sum of $25,000. 


CORRESPONDENCE. 

June 15, 1931. 

PALMAM QUI MERUIT FERAT. 

To the Editor: 

In reading the interesting paper by Dr. L. Levy 
on Autotransfusion and the animated discussion 
that followed, in the last issue of the Journal 
(June, 1931), I note that credit for the origin of 
this procedure is given by the Author and by other 
speakers, to Dr. Johann Thies, of Leipzig. This 
distinguished surgeon published his experience 
in 1914 when he applied this method for the relief 
of exsanguinated patients suffering from ruptured 
ectopic pregnancy. Thies no doubt believed that 
the method had originated with him, and practi- 
cally all the operators who have followed him 
share in this belief. Without in the least detract- 
ing from the undoubted merit of his enterprise or 
doubting that Thies was the first to apply the 
principle of autotransfusion to cases of ectopic 
pregnancy or to hemorrhages in the abdominal 
cavity, it is only fair to recall that as far as the 
application of the principle of self blood replace- 
ment, upon which autotransfusion is based, he 
was clearly antedated by Professor Halsted of 
Baltimore, who reported his experience with auto- 
transfusion or “'Blood Refusion” as he preferred 
to call it, to the New York Surgical Society on 
November 13, 1883 — thus anticipating the Ger- 
man surgeon by thirty-one years; and, as far as 
the mere suggestion of the principle is concerned, 
Thies was preceded by one of his own country- 
men — Volkmann, of Halle, in 1865 — fifty-one 
years before Thies’ publication. 


70 


Louisiana State Medical Society 


Dr. Edmond Souchon, in opening the discussion 
of Dr. Levy’s paper, took up in a very praise- 
worthy way, the historical phases of the subject 
and traced the concept of autotransfusion to Wil- 
liam Highmore, of Sherborne, Eng., who in 1874 
suggested and recommended that the shed blood 
in postpartum hemorrhage should be collected and 
reinjected into the depleted .mother after it had 
been defibrinated and warmed, using “a Higgin- 
son syringe and transfusion pipe for the purpose.” 

But Dr. Halsted in his very thorough paper of 
1883 on “Blood refusion in the treatment of car- 
bonic oxide poisoning,” pursued his investigations 
much further and found, as previously stated, 
that “Volkmann, in 1868, when discussing disarti- 
culation of the hip, suggested the feasability of 
collecting the blood lost in this operation and re- 
turning it to the loser through the divided femoral 
vein. Esmarch, in 1873, endeavored to act in 
accordance with Volkmann’s suggestion, but his 
patient died while preparations were being made 
for the reinfusion. Hueter (1874), in frost gan- 
grene of both feet transfused 350 c.c. of the 
patient’s own blood, defibrinated, into the left pos- 
terior tibial artery, and believed he thereby pre- 
served a portion of the frozen parts. “The right 
foot, untransfused, underwent an extensive for- 
feiture.” Dr. Halsted quotes Highmore as the 
last contributor to the history of autotransfusion 
in 1874, before he (Halsted) had successfully 
applied the principle of Refusion in 1883. 

Dr. Souchon in his discussion refers to A. G. 
Miller, of Edinburgh, as the first to actually apply 
Highmore’s suggestion in 1885, in a case of ampu- 
tation of the hip, and he also refers to Dr. Duncan 
as advocating and practicing the method of auto- 
transfusion in 1865. This date evidently is a mis- 
quotation through inadvertence, as the Duncan 
referred to is J. Duncan who published a paper 
on “Re-infusion of Blood in Primary and other 
Amputations,” Brit. Med. Jnl. 1:192, 1886. It is 
evident that neither Miller or Duncan had any 
knowledge of Halsted’s previous publication in 
1883, in which the earlier observations of Volk- 
mann, Esmarch and Hueter are clearly stated. 

My purpose in this communication is chiefly 
to call attention to the fact that Dr. Halsted was 
the first to apply the principle of reinfusion or 
autotransfusion in America nearly fifty years ago, 


and that he was the first, in surgical history, to 
utilize this principle in the treatment of illum- 
nating gas poisoning — one of the most frequent 
and fatal forms of accidental and suicidal intoxi- 
cation. 

In the discussion of a valuable paper on “Re- 
fusion of Blood in Hemorrhage,” read by Dr. Ed- 
ward J. Klopp, of Philadelphia, at a meeting of 
the American Surgical Association, May 2, 1922 
(see Transactions Vol. 40, 1922), in which this 
author had attributed the origin of autotransfu- 
sion to Johann Thies, Dr. Halstead, who was pres- 
ent reminded the Society that this procedure had 
been the subject of his first published contribution 
to medical literature, nearly forty years before 
Dr. Klopp had resurrected the subject at this meet- 
ing. Going back to his original paper, Dr. Halsted 
stated that while surgeon in charge of the old 
Chambers Street Hospital, a relief branch of the 
New York Hospital, in the early 8CTs, “we saw 
many cases of gas poisoning, most of them con- 
tributed by the night boats plying between New 
York and ports along Long Island Sound. In a 
number of instances, I practiced what I termed 
refusion. The patients were freely bled and their 
blood collected, defibrinated and returned to them 
by way of the radial artery. In the process of 
defibrination the blood was sufficiently aerated to 
deprive it of its toxic properties. In this way 
not only the lost blood volume was replaced, but 
the oxygen carrying function of the blood re- 
stored. The results obtained by this procedure 
were remarkable. Patients who were comatose 
would, after the bleeding, became conscious and 
even quite rational, and upon the reinfusion, the 
detoxicated and oxygenated blood would recover 
them still further and permanently.” 

The technic of reinfusion has been enormously 
simplified in recent years, by substituting the in- 
travenous for the intraarterial injection of citrated 
blood and by the use of the apparatus originally 
devised by the late lamented Dr. Kells, of this 
city, and now universally used for the aspiration 
of blood and other fluids collected in the body 
cavities or in the operative field, as is done sys- 
tematically by Cushing, De Martel and other brain 
surgeons. In this way, practically all the blood 
can be aspirated and held in an aseptic container 
where it can be citrated and filtered. The appar- 


Louisiana State Medical Society 


71 


ent simplicity of the method accounts for the en- 
thusiasm with which the principle of reinfusion 
has been recently revived and is finding many un- 
thought of applications — the most important of 
these having been well brought out in the discus- 
sion of Dr. Levy’s paper by Dr. Souchon, and his 
reference to the advantages and disadvantages of 
the citrated as compared with whole blood, is also 
timely and important. 

There is much that can be said apart from the 
technic, in regard to the indications and contra- 
indications of autotransfusion. It is not always 
so benign in its effects as its modern simplicity 
and published reports suggest. There is danger 
in the abuse of this auto-blood therapy. For it 
must be admitted that autotransfusion is an un- 
necessary procedure in the average case of rup- 
tured ectopic pregnancy. Klopp, in reporting 
eleven cases of re-infusion for pelvic hemorrhage, 
in the paper referred to (1922), also reported 107 
consecutive cases of ruptured ectopic pregnancies 
treated in the gynecological department of the 
Jefferson Hospital, Philadelphia, with 8 deaths from 
all causes. He quoted Arnim, of Kiel, who reported 
(1919) 351 cases of extrauterine gravidity oper- 
ated on during the years 1910-1919, without re- 
. fusion, and that of these, 8 died. It is not clear, 
however, that all these were ruptured cases. Many 
more statistics have accumulated since 1922, in 
which even a lower mortality is exhibited in con- 
sequence of earlier diagnoses and earlier opera- 
tions. In the majority of these cases, the patient 
will rally when the hemorrhage is arrested and 
the blood volume is restored by an intermittent 
or continuous isotonic intravenous salt or glucose 
solution, provided the abdomen is quickly closed, 
leaving the extravasated blood in the cavity to be 
absorbed. This "is "equivalent to an intraperi- 
toneal autotransfusion .which only differs from 
the intravenous injection of blood in the relatively 
slow rate of absorption. 

The inability to sterilize the blood collected 
from sources of dubious asepticity in the abdomen 
particularly, will prevent its application in many 
operations in which the blood could be most prof- 
itably utilized, but in which its probable contami- 
nation prohibits its injection into the circulation, 
as in bleeding gun shot wounds of the abdomen, 
placeta previa, and post partium hemorrhage. 


While complimenting Dr. Levy and Dr. Sims, 
on the happy results of their first clinical applica- 
tion of the method of autotransfusion in this city, 
I trust the future contributors to this subject, here 
and elsewhere, will not forget that credit for the 
first application of autotransfusion in America is 
due to an American surgeon — Halsted — and not 
to a belated inspiration imported from foreign 
sources. Rudolph Matas, M. D. 

Note: The reader interested in the early his- 

tory of this subject will find all the necessary data 
in Dr. Halsted’s original paper on “Blood Re- 
fusion in the Treatment of Carbonic Oxide Poi- 
soning” in Yol. 1 of the two volume memorial 
edition of the “Collected Papers and Addresses of 
William Stewart Halsted,” edited by Dr. W. C. 
Burkett and issued- by the Johns Hopkins Press 
in 1924. 


May 27, 1931. 

Dear Sir: 

I notice in your Journal of May, page 833, an 
article from Dr. W. H. Schudder of Mayersville 
promising an article from me on the treatment of 
malarial hematura. I beg to state as I never 
write articles for medical journals or medical so- 
cieties will enclose you an announcement of my 
fiftieth graduation anniversary, showing some of 
the work I have done. 

Yours truly, 

Dr. T. A. Heath, 

Shiloh Box, 
Filter, Miss. 

(Enclosure) 

Fifty years ago this month I graduated at the 
Hospital College of Medicine, Louisville, Ken- 
tucky, when I began the practice of medicine in 
this malarial delta. I have treated many of the 
most malignant forms of malarial hematura and 
never lost but one — never had but three to have 
a return of the disease, which I checked very 
nicely. I have treated other forms of malaria suc- 
cessfully, many not having a return of the disease 
for years. I have relieved many cases of malaria 
from twenty-four to forty-eight hours with only 
a few doses of my malarial powders. 

T. A. Heath, M. D. 


MISSISSIPPI STATE MEDICAL ASSOCIATION NEWS 

L. S. Lippincott, Editor 

Jacob S. Ullman, Associate Editor D. W. Jones, Associate Editor 


SHARKEY COUNTY. 

Dr. and Mrs. H. S. Goodman, Cary, attended 
the meeting of the Mississippi State Medical 
Association in Jackson. 

Dr. and Mrs. M. J. Few, Rolling Fork, attended 
the State Medical meeting in Jackson. 

Dr. and Mrs. W. C. Pool, Cary, attended the 
State Medical Meeting in Jackson. Mrs. Pool 
attended the meetings of the Woman’s Auxiliary. 

Miss Katie Martin, daughter of the Late Dr. 
L. E. Martin, Anguilla, has gone to California, 
where she will marry Mr. Allen Selby. 

W. C. POOL, County Editor. 


ATTALA COUNTY. 

We are glad to report one of our physicians, 
Dr. J. W. Bailey, (very much improved from a 
serious operation ihe underwent at the Baptist 
Hospital, Jackson,/ He has returned to his home 
at Kosciusko, and we hope he will have a speedy 
recovery. C. A. PENDER, County Editor. 


ADAMS COUNTY. 

A number of very lovely and informal parties 
have been given for the graduating nurses of the 
Natchez Sanatorium. Among the entertainments 
was that given by the junior nurses to the seniors, 
entertaining at the Nurses’ Home in Franklin 
Street. Throughout the lower floor, beautiful 
flowers were arranged, adding brightness to the 
setting. Refreshments were served. 

The graduation exercises for the nurses of the 
Natchez Sanatorium were held at five o’clock in 
the afternoon on June 2, at the Rendezvous. A 
social hour and dancing followed the exercises. 

Mr. George Dicks, son of Dr. J. W. D. Dicks, 
returned to Natchez June 6, from Old Hickory, 
Tennessee, where he had been visiting in the home 
of his brother-in-law and sister, Mr. and Mrs. 
Lyman Darling. 

Mrs. Nita Beer returned recently from a visit 
in New Orleans and is again a guest in the home 
of her brother-in-law and sister, Dr. and Mrs. 
Philip Beekman. 

Mrs. George Tiche is again at home with her 
son-in-law and daughter, Dr. and Mrs. Marcus 
Beekman, after a visit of several months with 
another daughter, Mrs. W. D. Hobgood and Mr. 
Hobgood at their home in Traylake. Mrs. Tiche 


will remain in Natchez for the greater part of 
the summer. 

Miss Mary Tiche and Miss Lynda Bray, of 
Athens, Goergia, were recent guests to Miss 
Tiche’s brother-in-law and sister, Dr. and Mrs. 
Marcus Beekman. 

Dr. and Mrs. Marcus Beekman entertained most 
beautifully at a recent supper party, featuring 
Mrs. C. L. Braman and her daughter, Miss Mary 
Braman, of Providence, Rhode Island, house guests 
of their relatives, Mr. and Mrs. S. Beekman Laub. 

Dr. J. S. Ullman has the sincere sympathy of 
his many friends in the loss of his brother, Aubrey 
M. Ullman, who died June 4, in Los Angeles, 
California. 

A very interesting report of the meeting of 
the Mississippi State Medical Association in Jack- 
son by Dr. E. E. Benoist was the feature of 
recent regular meeting of the Medical Society of 
Natchez. Dr. Benoist discussed the various papers 
which were presented at the State Meeting. The 
talk was thoroughly enjoyed by everyone and was 
followed by a round table discussion. 

At the regular meeting of the board of trustees 
of the Natchez Hospital on June 4, Dr. P. H. Ray- 
burn was elected house surgeon. The staff of 
the hospital as now constituted consists of: Dr. 
J. A. Rayburn, superintendent; Dr. G. H. Butler, 
assistant superintendent; Dr. P. H. Rayburn, house 
surgeon; W. D. Deterly, Secretary. 

Trustees attending the meeting were Mrs. Alma 
Spaulding, Fayette; Mrs. W. F. Tucker, Wood- 
ville; J. J. Whittington, Bude; J. E. Flowers, 
Wilkinson; Dr. E. E. Benoist, Natchez; Mrs R. 
T. Clark, Natchez; Mrs. Katie Ogden, Natchez; 
John R. Junkin, Natchez; and W. A. Lowry, 
Natchez. 

L. WALLIN, County Editor. 


MADISON COUNTY. 

I haven’t much to report from Madison County 
for this month but will try to find some items for 
you as the months go by. 

Among the Madison County doctors attending 
the Mississippi State Medical Association at Jack- 
son were Drs. Howell, Smith, and Durfey of 
Canton. 

Dr. John M. Melvin and Mrs. Melvin are in 
Baltimore where Mrs. Melvin is under treatment. 


Mississippi State Medical Association 


73 


Miss Mamie Davis, Superintendent of the King’s 
Daughters’ Hospital, Canton, spent several days 
at home recently. 

F. P. DURFEY. 


PONTOTOC COUNTY. 

At this time (June 8) all of Pontotoc County 
is looking a week ahead to the meeting of the 
North East Mississippi Thirteen Counties Medical 
Society which meets at Houlka in Chickasaw 
County. The program is very interesting and 
we wish all our fellows in the State could attend. 
We are expecting one hundred percent attendance 
from Pontotoc County. 

Dr. J. H. Windham of Ecru, one of our ablest 
doctors, enjoys himself and relaxes occasionally 
by fishing. During the leisure days one may see 
him with his cane and can of bait. After the 
.patient is cared for he sometimes stops at a good 
place and tries his hand at fishing. 

Dr. R. P. Donaldson, Pontotoc, is our county 
health officer. Besides his private practice which 
keeps him pretty busy, he also looks after the 
health of the county in general. Though we have 
a splendid health officer we seldom have to use 
him as we have very few epidemics. Small pox 
and such stay away from us pretty well. 

Dr. J. D. Neel and Dr. E. B. Burns at Ecru in 
the northern part of the county are partners. 
They are very much interested in intravenous 
therapy and practice it more or less every day as 
the occasion permits. 

Dr. Z. A. Dorsey, Troy, in the south eastern 
part of the county, will present an interesting 
paper on “Focal Infection” at the meeting next 
week at Houlka. 

Dr. O. F. Carr and Dr. Dexter Dunavant, both 
of Pontotoc, are busy physicians. Dr. Dunavant 
helped to represent Pontotoc county at the recent 
State medical meeting at Jackson. 

Yours for a bigger and better Mississippi State 
Medical Society. 

ELIAM B. BURNS, County Editor. 


LINCOLN COUNTY. 

The Tri-County Medical Society met June 9, 
at 12 noon, in regular quarterly session at the 
Inez Hotel, Brookhaven, with a good attendance. 
After dinner in the cafe, the business and scien- 
tific programs were entered into. 

Guest of honor was President John C. Culley, 
Oxford, this being his first official visit since his 
elevation to his merited place in the State Medi- 
cal Association. He addressed the society on the 


needs of better and closer organization in the 
profession and spoke of the community hospital 
needs and the medical department of the Univer- 
sity of Mississippi. 

Dr. Culley enters into his work with zeal and 
confidence in his organization, committees, and 
friends over the State. We predict a good year’s 
history in Mississippi medicine under his guidance. 
He was called back by wire to his home thereby 
cutting short his too brief visit with this society. 

Dr. W. E. Clark, Assistant Superintendent of 
the Mississippi State Hospital, read an interest- 
ing paper on, “Psychoneuroses Following Influ- 
enza.” This paper brought out some very inter- 
esting things for the general practitioner and was 
discussed by many of the members and visitors. 
Dr. Clark has had a very rich experience in this 
line of practice and his paper was the more 
appreciated. 

Dr. John Bullock, Jackson, read a paper on, 
“Cause and Treatment of Ileo-colitis,” which 
evoked much interest, and showed the scientific 
developments on this subject. 

The Society went on record as favoring the 
community hospital idea as promulgated at the 
recent meeting of the Mississippi State Medical 
Association meeting and gave President Culley a 
vote of thanks for his visit and confidence in his 
work. 

The Tri-County Society will meet next in Mon- 
ticelloo, “On the Pearl,” September 8, as guest of 
the Lawrence County physicians, who are princes 
as good fellows and entertainers. 

This society mourns with her sister society in 
the loss of our good friend and charter member 
of the old Tri-County Medical Society, the beloved 
Dr. L. D. Dickerson of McComb. In his passing 
not only South Mississippi but the entire state has 
lost a good citizen and medical man. Suitable 
resolutions were passed on his demise. 

Dr. John T. Butler, without doubt the most 
active of the older practitioners of the State, is 
a “guest” in the King’s Daughters’ Hospital, 
Brookhaven, for a few days, suffering from herpes 
zoster. His loyal clientele and long list of medi- 
cal friends wish for him a speedy recovery. Dr. 
Butler will celebrate the 78th milestone in his 
history on June 19th, and the 54th in very active 
medical work, since he still makes night calls reg- 
ularly. 

The staff of the King’s Daughters’ Hospital met 
in regular monthly session, Tuesday evening, with 
discussions of interesting local problems and the 
annual re-organization and election of officers as 


74 


Mississippi State Medical Association 


follows: Dr. 0. N. Arrington, President; Dr. H. R. 
Fairfax, Vice-President; Dr. -J. R. Markette, Sec- 
retary. 

Miss Merchant of Alabama is now the very effi- 
cient technician of the King’s Daughters’ Hospital 
and has already won her way into the good graces 
of the board and staff. 

W. H. FRIZELL, County Editor. 


PIKE COUNTY MEDICAL SOCIETY. 

DR. L. D. DICKERSON. 

McComb and Pike County suffered a vital blow 
in the death of Dr. L. D. Dickerson on June 4, 
from complications following appendectomy. 

Dr. Dickerson had been in McComb for about 
36 years and was held in the highest regard as a 
physician and surgeon and as a citizen. He was 
always interested in the betterment of the prac- 
tice of medicine, so made various trips to the 
medical centers that he might be better equipped 
to render his patients better care. He was a 
strong believer in organized medicine and he lived 
to see the Commonwealth Fund select Pike County 
as one of the two counties in Mississippi in which 
to place a unit. Dr. Dickerson was especially in- 
terested in the up-building of the little city that 
he had seen grow from a village and to this he 
gave unsparingly of his time and money and 
McComb is better off by his having lived here. 

Louis Dent Dickerson was born in Simpson 
County, September 11, 1869, the son of Judge 
John and Jane (Mullen) Dickerson. He was 
graduated from the Bellevue Hospital Medical 
College in 1894. He was a member of the Amer- 
ican Medical Association, Mississippi State Med- 
ical Association, the Tri-County and Pike County 
Medical Societies, and was always active in the 
State and local societies. His religious faith was 
that of the Baptist church, of which he was a 
deacon. On October 23, 1895, he was marired 
to Miss Ada M. Williams, the daughter of John 
H. and Sarah (Brinson) Williams of Lawrence 
County. To this union there were born two chil- 
dren, who with their mother survive the doctor. 


Dr. F. J. Underwood was in McComb, May 29, 
attending to the scholarships for doctors that are 
to be given by the Commonwealth Fund. 

Owing to the fact that Dr. Dickerson was dying 
on our meeting day, no meeting was held. 

L. J. RUTLEDGE, Secretary. 


SOUTH MISSISSIPPI MEDICAL SOCIETY. 

A regular meeting of the South Mississippi Med- 
ical Society was held at the Pinehurst Hotel, 
Laurel, on June 11, beginning at 3 p. m. 

The program included: 

1. Cystic Ovaries and Other Tumors of the 
Uterine Adnexa Complicating Pregnancy. — Dr. J. 
S. Gatlin, Laurel. 

2. A Plea for a More Earnest Effort in Our 
Examinations and Diagnosis by Utilizing Our More 
Common Laboratory Methods. — Dr. J. K. Oates, 
Laurel. 

3. The Treatment of Empyema by Aspiration 
and Air Replacement. — Dr. R. R. Roberts, New 
Orleans, Louisiana. 

4. Osteomyelitis (Illustrated with Lantern 
Slides). — Dr. Isidore Cohn, New Orleans, Lou- 
isiana. 

5. Address by President of the Mississippi 
State Medical Association. — Dr. John C. Culley, 
Oxford. 

After a business session, dinner was served 
at the Pinehurst Hotel. 


WINSTON COUNTY. 

The doctors of the Winston County Medical 
Fraternity with their wives, enjoyed a fish fry, 
May 12, the day was extremely pleasant and 
nearly all of the doctors were there. 

Dr. T. C. Suttle, who came back from Bison, 
North Dakota, some months back, united with the 
Medical Fraternity at the last meeting. 

We note with interest the recent marriage of 
Mr. Everett Watkins to Miss Hazel Kilpatrick. 
Mr. Watkins is the son of Dr. H. B. Watkins and 
the bride is the daughter of Dr. T. F. Kilpatrick, 
all of Noxapater. We congratulate them. 

M. L. MONTGOMERY, County Editor. 


BOLIVAR COUNTY. 

The Delta Medical Society met at Cleveland, on 
April 8, with 125 doctors in attendance. The 
Society went on record as favoring the commun- 
ity hospital in preference tod the present hospital 
system. After the afternoon session, which was 
devoted to an interesting and instructive program, 
all enjoyed the bountiful banquet given by the 
doctors of Bolivar County. 

Dr. J. D. Simmons, Gunnison, reported a case 
of undulant fever and stated that he was using 
the vaccine treatment with hopes of an early re- 
covery of the patient. 


Mississippi State Medical Association 


75 


Under the efficient management of Mrs. W. A. 
Shelby, the King’s Daughters’ Hospital of Rose- 
dale, has been able to continue its great service to 
the community. 

Mrs. Shelby is serving without pay while our 
people are staggering through this financial crisis. 

In my drive for new members throughout the 
past year I feel that many friends stood by me 
most loyally and I thank them from the bottom of 
my heart. 

As in the past 23 years I have worked for or- 
ganized medicine and medical ethics, just so will 
I be laboring in the future. 

C. W. PATTERSON, County Editor. 


NORTHEAST MISSISSIPPI THIRTEEN 
COUNTY MEDICAL SOCIETY. 

Following is the announcement of the last reg- 
ular meeting of the Northeast Mississippi Thirteen 
County Medical Society: 

HOULKA DAY 

You are cordially invited to attend 
the 

Regular Quarterly Meeting 
of the 

Northeast Mississippi 13 County 
Medical Society 
to be held in the 
First Baptist Church at Houlka 
Tuesday, June 16th, 1 p. m. 

Houlka is in Chickasaw County, ten miles from 
Houston and last, but not least, is the home of 
our beloved and honored member, Dr. W. C. 
Walker. If you have any doubts about the great- 
ness of Houlka, attend this meeting. The North 
Mississippi Medical Society, will be our guests 
and share in the program. 

Please be prompt. 

Bring this program with you. 

C. E. Boyd, President 

J. M. Acker, Jr., Secretary. 

PROGRAM. 

1. Meeting called to order by Dr. C. E. Boyd, 
President. 

2. Invocation. — Rev. S. P. Andrews. 

3 Reading and adoption of minutes of the 
last meeting. 

4. Focal Infection. — Dr. Z. A. Dorsey. 

Discussion opened by Drs. Pegram and Guinn. 

5. Report of Allergic Cases. — Dr. A. H. Lit- 
tle, Oxford. 


Discussion general. 

6. Dystocia With Special Reference to the 
Occiput Posterior. — Dr. Percy Toombs, Memphis, 
Tennessee. 

Discussion general. 

7. Ureteral Strictures — Symptoms, Diagnosis 
and Treatment. — Dr. L. C. Feemster, Jr. 

Discussion opened by Drs. Ewing and Philpot. 

8. Differential Diagnosis of Heart Murmurs in 
Children. — Dr. R. E. Priest. 

Discussion opened by Drs. Reed and Adams. 

9. Business session. 

Entertainment. 

6 p. m. Picnic Dinner. 

Address of Welcome. — Miss Moss Davis. 

Response. — Mr. I. B. Tigrett, President G. M. 
& N. R. R. 


MONROE COUNTY. 

Just a month ago, I wrote you that I was on my 
toes ready to start to Jackson to the meeting of 
the Association. Well, I went and I am more 
than glad that I did, for the memory of the brief 
association with so many of my friends lingers 
as a benediction. I would not have missed the 
warm handclasp of my good friend, Louis Dicker- 
son, for many times the cost of the trip. How 
glad I am that I did not, then, know that it was 
to be the last time I should see him. Yet I think 
it might have been good to tell him I loved him. 
I knew Louis Dickerson — I have seen him tested, 
and he proved himself to be a man (what more 
need be said?). “When shall we see his like 
again?” 

In my opinion the meeting was a success in all 
respects. Though Dr. Howard labored under phy- 
sical handicap, he did not fail to live up to his 
standard — indeed, “Richard was himself again.” 

The nominating committee honored the associa- 
tion when it presented the three names it did 
from which to choose a president-elect. A mis- 
take could not have been made no matter which 
had been chosen. Although the youngest of the 
three was drafted for two years of hard work, I 
am sure we will get honest, capable and satisfac- 
tory service. Dr. Acker (Jamie, as his friends 
love to call him), is a worker for the cause. He 
has been secretary of his society for several years 
and though he succeeded Dr. Underwood, he has 
made good to the fullest. We appreciate him and 
we stand by and for him. If all of the member- 


76 


Mississippi State Medical Association 


ship will help him, I know that his work will bear 
much good fruit. 

One week from today the greatest medical meet- 
ing of all time, so far as Mississippi is concerned, 
will be held at Houlka. The Thirteen Counties 
will have the North Mississippi Medical Society 
as guest then and there. More correctly speak- 
ing, Drs. Walker and Hood will have the members 
of these two societies — nineteen counties — as their 
guests. What a gathering that will be! In my 
next I hope to be able to tell you something of 
this meeting. 

No news — health good — times hard — weather 
fine — fishing fair. 

G. S. BRYAN, County Editor. 

It is with much regret that we learn that Dr. 
W. G. Gill, Newton, Councilor for the Sixth Dis- 
trict of the Mississippi State Medical Association, 
has been confined to his home and hospital for 
the past three months, suffering with undulant 
or malta fever. 


TISHOMINGO COUNTY. 

Dr. D. D. Johnson, Belmont, was a patient for 
a few days of the last week in May at a hospital 
in Memphis, where he underwent a submucous 
resection of his nasal septum. 

KENNETH P. McCRAE, County Editor. 


WEBSTER COUNTY 

We have twelve physicians in Webster County, 
most of them in the evening of their professional 
life, but since preventive medicine rather than 
curative medicine is make such progress, we have 
about worked ourselves out of a job. 

We still have plenty of automobile accidents 
and midwives are very scarce, so you can readily 
see we are still keeping on in Webster County. 

W. H. CURRY, County Editor. 


PONTOTOC COUNTY. 

News are very scarce here. Dr. Robert Going, 
who was located in Pontotoc County, Houlka, R. 
F. D., has recently moved to Calhoun County, 
Calhoun City. 

R. P. DONALDSON, County Editor. 


PRENTISS COUNTY. 

Dr. and Mrs. W. H. Sutherland visited their 
son, who is completing his third year in medicine, 
at Louisville, Kentucky, recently. 

Dr. and Mrs. W. H. Anderson attended the State 
Medical Meeting at Jackson in May. 


Dr. J. C. Vandiver, Baldwyn, has recently re- 
turned home from the Northeast Mississippi Hos- 
pital where he underwent a gallbladder operation 
several weeks ago. Dr. Vandiver is convalescing 
slowly but nicely. 

Dr. Otis S. Warr, Memphis, Tennessee, was in 
Booneville recently on a professional visit. 

Dr. William M. Adams has recently returned 
from New Orleans, where he has been taking 
post-graduate work. 

ROBERT B. CUNNINGHAM, County Editor. 


YAZOO COUNTY. 

Yazoo doctors are rather quiet. You know we 
did not raise much corn last year so look out 
when the new crop comes in. 

The following Doctors attended the State Med- 
ical Association meeting in Jackson recently: Dr. 
Joe Roberts, Thornton; Drs. John Darrington, Gil- 
ruth Darrington, O. H. Swayze, Carl Day, J. T. 
Rainer, W. D. McCalip, H. L. McCalip, all of 
Yazoo City, I believe were all. 

Dr. S. H. Woods, Benton, left recently for 
Panama where he has been assigned to duty in 
government medical work. Mrs. Woods and their 
children will leave later to join Dr. Woods in 
their new home. 

Will try to do better next time. 

C. M. COKER, County Editor. 


DEATHS OF MISSISSIPPI DOCTORS. 

Robert H. Stewart, Poplarville; died following 
operation for mastoid and sinus trouble; March 
16, 1931, at New Orleans, Louisiana. Born Pop- 
larville, May 6, 1885. 

William Henry Whitaker, Grenada; chronic 
nephritis, cerebroembolus ; at Granade, March 19, 
1931. Born Mississippi, 1860. 

J. A. Ashford, Bolton; diabetes mellitus; sen- 
ility; March 26, 1931, at Bolton. Born Chester, 
South Carolina, July 4, 1852. 

G. M. Westmoreland, Batesville; April, 1931. 
Born Spartanburg County, South Carolina, April 
20, 1853. 

G. C. Stone, Saltillo; at Saltillo, April 7, 1931. 
Born at Tremont, September 12, 1879. 

W. S. Weissinger, Hernando; chronic myocardi- 
tis; at DeSoto County, April 15, 1931. Born Au- 
gusta, Georgia, 1848. 

Samuel M. Jordan, Georgetown; Gangrene; 
April 19, 1931, at Georgetown. Born Tennessee, 
1848. 


Mississippi State Medical Association 


77 


George David Mason, Lumberton; pneumonia 
followed by encephalitis; April 26, 1931, at Lum- 
berton. Born July 30, 1887, Isney, Alabama. 

J. B. Sims; Aberdeen; apoplexy; Aberdeen, May 
10, 1931. Born Aberdeen, February 19, 1861. 

Joseph M. Catchings, Hazlehurst, heart attack; 
at Hazelhurst, May 18, 1931. Born at Georgetown, 
March 20, 1857. 

E. G. Hamilton, Greenwood. Born at Abingdon, 
Virginia, November 20, 1881. 

Kossuth R. Cammack, Chicora. Born America, 
1888. 


HOLMES COUNTY. 

The Holmes County Community Hospital at 
Lexington, the first county hospital in the State 
by the way, opened Monday, May 25. We now 
have eleven patients, ten of them operative. This 
hospital is not fully complete as yet but we are 
working. 

The Winona District Medical Society will meet 
in Lexington, July 6. We are going to have lunch, 
music, etc., and after the program, the new hospi- 
tal will be inspected. 

The hospital has a capacity of 35 beds, equipped 
throughout with the most modern equipment that 
could be secured, at a cost of about $65,000. 

We understand Dr. R. C. Elmore of Durant has 
discovered an absolutely infallible method for re- 
ducing his golf score. 

ROBERT M. STEPHENSON. 


TREASURER. 

Please announce in the New Orleans Medical 
and Surgical Journal that Treasurer I. W. Cooper 
of Meridian has resigned and that President Cul- 
ley has appointed Dr. E. L. Wilkins of Clarksdale 
temporary treasurer. The transfer of all funds 
and securities has been made. Treasurer Wilkins 
has made bond in the sum of fifteen thousand 
dollars, and the financial statement has been for- 
warded to the Budget and Finance Committee for 
its audit. The bond has been sent to the Council 
for its approval. 

T. M. DYE, Secretary. 


EAST MISSISSIPPI MEDICAL SOCIETY. 

The East Mississippi Medical Society met at 
the Benwalt Hotel, Philadelphia, Thursday, June 
18, at 3 p. m. The program: 

1. The Patient. — Mrs. Iva Lovell, Meridian. 

2. The Present Understanding and Limitations 
of the Term, Eczema. — Dr. R. W. Hall, Jackson. 


3. Symptoms of Colon Disfunction. — Dr. Hen- 
ry G. Rudner, Memphis, Tennessee. 

Immediately following the meeting a luncheon 
was served in the Benwalt Hotel. 

T. L. BENNETT, Secretary. 
COPIAH COUNTY. 


DR. J. M. CATCHINGS. 

Dr. J. M. Catchings of Hazlehurst, died May 18, 
from an acute heart attack. He had been sick 
for about two weeks, came home the 14th, and 
was thought to be better. 

Di\ Catchings was one of Copiah County’s best 
citizens and physicians. 

W. L. LITTLE, County Editor. 

AND THEY STILL OCCUR 

The Bureau of Communicable Diseases of the 
Mississippi State Board of Health reports for the 
month of March, Typhoid fever, 16; smallpox, 
177; diphtheria, 62; for April, typhoid fever, 29; 
smallpox, 308; diphtheria, 29. 

ALL PREVENTABLE DISEASES! 


NORTH MISSISSIPPI MEDICAL SOCIETY. 

The regular quarterly meeting of the North 
Mississippi Medical Society was held jointly with 
the Northeast Mississippi Thirteen Countries Med- 
ical Society at Houlka, June 16, beginning at 1 
p. m. The members of the North Mississippi So- 
ciety were the guests of the members of the North- 
east Mississippi Society. 

The North Mississippi Medical Society is in- 
deed proud to have the President of the State 
Medical Asosciation listed in its membership. 

The Mississippi State Medical Association al- 
most lost its President, Dr. John C. Culley, on 
June 9, when the airplane in which he was re- 
turning to Oxford crashed on landing. Fortu- 
nately the accident resulted in no serious in- 
juries to Dr. Culley. Dr. Culley had received 
an emergency call while attending the meeting 
of the Tri-County Medical Society at Brook- 
haven. He was also to have appeared on the 
program of the South Mississippi Medical Society 
at Laurel on June 11 but was unable to attend. 

Dr. and Mrs. A. H. Little, Jr., recently gave 
a tea honoring President J. C. Culley, at their 
beautiful residence in Oxford. Guests were the 
local doctors and their ladies, the members of the 
faculty of the University and their ladies, and the 


78 


Mississippi State Medical Association 


students of the medical department of the Uni- 
versity. In the receiving line were Dr. and Mrs. 
John C. Culley and Dr. and Mrs. A. H. Little. 

A. H. LITTLE, Secretary. 


MISSISSIPPI STATE BOARD OF HEALTH. 
“You may expect to have my name on the 
honor roll each month from now on. Enclosed 
are some items which you may wish to use.” 

FELIX J. UNDERWOOD. 


Dr. C. C. Applewhite of the State Board of 
Health attended the meeting of the Texas State 
Medical Association in Beaumont and delivered a 
paper entitled, “The Fundamental Principles of 
Public Health Administration.” 

Dr. L. L. Lumsden, Medical Officer of the U. 
S. Public Health Service, who is now stationed in 
New Orleans, Louisiana, was in Mississippi on 
May 29 conferring with health officials. 

Doctors C. A. Scamman, Lester J. Evans, and 
Miss Theresa Kraker, representatives of the Com- 
monwealth Fund of New York City, were in the 
State on May 29 interviewing applicants for medi- 
cal undergraduate and postgraduate scholarships, 
and scholarships for nurses. These representa- 
tives visited both Pike and Lauderdale counties 
during their stay here. Those to whom scholar- 
ships were awarded will be announced within a 
sihort time. 

The Mississippi State Board of Health met on 
June 23, 24, and 25. 

The Mississippi Follow-Up White House Con- 
ference on Child Health and Protection was held 
in Jackson on June 26 and 27. The program was 
as follows: 

Friday, June 26, 9 A. M. 

Registration All Day 
Governor Theodore G. Bilbo, Presiding 

Felix J. Underwood, M. D., General Chairman 


Music Jackson Boys’ Band 

Invocation Dr. Lawrence L. Cowan 

Pastor, Galloway Memorial Church, 
Jackson, Mississippi. 

Greetings Governor Theodore G. Bilbo 

Music Jackson Boys’ Band 


Statement from the Chairman. 

Address: “Community Responsibility and Co- 

Operation for Child Health and Protec- 
tion” Prof. W. F. Bond 

State Supt. of Education, Jackson, Miss. 


I. EDUCATION AND TRAINING 

In the Home Mrs. Ellen S. Woodward j 

Secretary, Mississippi State Board of Develop- 
ment and State Chairman, Better Homes in 
America, Jackson. 

Discussion-. Dr. John L. Sutton ; 

President, Mississippi Children’s Home Find- 
ing Society, Jackson. 

In the Church John C. Chambers ; 

Executive Secretary, Mississippi Conference 
Board of Christian Education, Jackson. 

In the School W. F. Bond, 

State Supt. of Education, Jackson. 

In the Community.... Blake W. Godfrey \ 

State Y. M. C. A. Secretary, Jackson. 

Friday, 2 P. M. 

II. THE HANDICAPPED CHILD. 

Prevention, Maintenance, and Protection. 

The Medical Care of Handicapped Children 
Harvey F. Garrison, M. D., Jackson and Frank 
Hagaman, M. D., Jackson. 

The Child in Employment J. W. Dugger, M. D. 

Director, Bureau of Industrial Hygiene and 
Factory Inspection, Jackson. 

Discussion.... Miss Marcia Gibbs 

Director, Y. M. C. A., Vocational School 
Jackson. 

The Physically Handicapped Child 

Mrs. Mary Baker 

Supervisor, Civilian Rehibilitation Work, 
State Department of Education, Jackson. 

Discussion Mrs. D. W. McBryde j 

Asst. Executive Secretary, State Commission 
for the Blind, Jackson. 

The Mentally Handicapped Child 

- H. H. Ramsey, M. D. . 

Supt. Mississippi State School, Ellisville. 

Discussion C. D. Mitchell, M. D. j 

Supt. State Insane Hospital, Jackson. 

The Delinquent Child Dr. N. B. Bond 

Professor of Sociology, University of Miss. 

Discussion Prof. B. L. Coulter 

Industrial Training School, Columbia. 

Friday, 8 P. M. 

History and Purpose of the White House Con- 
ference on Child Health and Protection 

Dr. H. E. Barnard 

Director of the White House Conference, 
Wa'sliington, D. C. 

Round Table Discussion. 


Mississippi State Medical Association 


79 


Saturday, June 27, 9 A. M. 

Registration. 


Music... Jackson’s Boys’ Band 

Invocation Rev. P. O’Rielly 


Catholic Church, Jackson. 

Devising a Better Civilization 

Mrs. Walter McNab Miller 

American Child Health Ass’n., 

New York, N. Y. 

III. MEDICAL SERVICE. 

Prenatal and Maternal Care 

James R. McCord, M. D. 

Emory University, Atlanta, Georgia. 

Discussion J. H. Janney, M. D. 

Director, Rockefeller Foundation Training 
Station for Health Workers, Indianola. 

Growth and Development. .Robert A. Strong, M. D. 
Professor of Pediatrics, Tulane University, 
New Orleans, La. 

Discussion .. .Noel C. Womack, M. D. 

Jackson Infirmary, Jackson. 

Recreation and Physical Education 

Miss Gladys Eyrich 

State Board of Health, Jackson. 

Discussion ...Miss Ruth Beeson 

Playground Director, Jackson. 

Function of Health Workers in the Care of 

Preschool and School Children 

F. Michael Smith, M. D. 

Director, Warren County Health Depart- 
ment, Vicksburg. 

Discussion Miss Mary D. Osborne 

Supervisor, Division of Maternal and Child 
Hygiene, State Board of Health, Jackson. 

Closing Session. 

Needed Legislation and Follow-Up Plans. 

Mrs. W. D. Cook 

President, State Parent-Teacher Ass’n., Forest. 

PLEDGE OF ALLEGIANCE. 


Dr. J. W. Cox of the American Society for the 
Control of Cancer, visited the State Board of 
Health while in Jackson attending the meeting of 
the State Medical Association. Dr. Cox addressed 
the Public Health Section of the Medical Associ- 
ation. 

Examination of applicants for medical licenses 
were held at the New Capitol on June 24 and 25. 
On the 24th, examinations on the first two year’s 
medical course were given, and on the 25th, 
evaminations were conducted on the last two 
year’s medical course. 


Applications by reciprocity for license to prac- 
tice medicine in Mississippi were considered on 
the first day of the meeting of the State Board 
of Health, June 23. 

Recently a preschool clinic was held at Leland, 
Mississippi. The clinic was plannned by Miss 
Lucile Brewer and was held with the assistance 
of the physicians and dentists of the county and 
the personnel of the Washington County Health 
Department. Thirty-eight preschool children were 
given thorough examinations and the parents were 
given advice relative to having any defect existing 
corrected. Each child was given a Schick test to 
determine susceptibility to diphtheria. Toxin-anti- 
toxin, typhoid, and smallpox vaccine will be given 
those needing it during the summer months. It 
is believed that having the pupils enter school 
with no physical handicaps and protected against 
preventable diseases will be invaluable to both 
teacher and pupil. 

Recent visitors to the State Board of Health: 
Dr. C. St. C. Guild, American Public Health As- 
sociation, New York City; Dr. W. F. Walker, The 
Commonwealth Fund, New York City; Dr. William 
DeKleine, American Red Cross, Washington, D. C. ; 
Dr. James R. McCord, Emory University, Atlanta, 
Georgia; Mrs. Miriam Birdseye, U. S. Extension 
Department, Washington, D. C.; Mrs. Walter Mc- 
Nab Miller, American Child Health Association, 
New York City; Arthur J. Strawson, National 
Tuberculosis Association, New York City; Dr. M. 
Fline Haralson, Chief Quarantine Officer, The 
Panama Canal; Dr. R. A. Vonderlehr and Dr. O. 
C. Wenger of the Public Health Service; Dr. R. 
J. Enochs, Choctaw Indian Agency, Philadelphia. 
Dr. Enochs was accompanied by Dr. and Mrs. Lee 
Bates of Cornell University and the U. S. Bureau 
of Indian Affairs, and Miss Mable C. Head. 

Dr. Charles W. Suit, State Health Officer of 
Arizona, spent several days recently observing 
public health work in Mississippi. Dr. Suit was 
accompanied by his daughter, Alice Suit. 


HARRISON-STONE-HANCOCK COUNTIES 
MEDICAL SOCIETY. 

The Harrison-Stone-Hancock Counties Medical 
Society met in regular session Wednesday, June 3, 
at the King’s Daughters’ Hospital, Gulfport. The 
program consisted of reports from the delegates 
to the Mississippi State Medical Association. 
Dr. R. W. Burnett reported for Harrison County 
and Dr. C. M. Shipp reported for Hancock County. 

I wish to report the illness of Dr. J. G. Foun- 
tain, of Gulfport, who is recovering very rapidly; 
also the illness of Dr. W. W. Eley, of Biloxi. It 
is my understanding that Dr. Eley is also rapidly 
recovering. Dr. D. G. Rafferty, of Pass Chris- 


80 


Mississippi State Medical Association 


tian, has also been ill at the King’s Daughters’ 
Hospital at Gulfport, but has recovered sufficiently 
to return to his home. 

The Harrison-Stone-Hancock Counties Medical 
Society will have its next regular meeting at the 
King’s Daughters’ Hospital, Gulfport, on July 1. 
The subject will be Infectious Mononucleosis, lead 
by Dr. W. A. Dearman, Gulfport. 

CUMMINGS H. McCALL, Secretary. 


VICKSBURG SANITARIUM. 

The regular monthly meeting of the staff of the 
Vicksburg Sanitarium was held on Wednesday, 
June 10. 

Moving pictures, Colies Fracture and the 
Anatomy of the Abdominal Viscera were shown 
through the courtesy of the Petrolagar Labora- 
tories. 

Special case reports presented: 

1. Fracture of Cervical Vertebra. — Dr. A. 
Street. 

2. Carcinoma of the Cecum. — Dr. J. A. K. 
Birchett, Jr. 

3. Double Vagina with Two Distinct Uteri. — 
Dr. S. W. Johnston. 

4. Subacute Mastoiditis with Rupture Inter- 
nally and Externally. — Dr. C. J. Edwards. 

Selected radiographic studies were shown as 
follows: Fracture of cervical vertebra (ambula- 

tory); Foreign Body embedded in thyroid; Mas- 
toiditis; Cholelithiasis (two cases) ; Renal calcu- 
lus; Stricture of rectum; Carcinoma of colon; 
Lung abscess; Pulmonary tuberculosis. 

The meeting closed with a lunch. 


CENTRAL MEDICAL SOCIETY. 

At the regular meeting of the Central Medical 
Society on Tuesday, June 16, at 7:30 P. M., at 
the Edwards Hotel, a resume of the papers of the 
different sections of the State Association was 
presented and a general discussion of interesting 
papers featured. 

The following reported on the various sections: 
Surgery, Dr. T. P. Sparks; Medicine, Dr. G. W. F. 
Rembert; Radiology, Dr. E. B. Van Ness; Public 
Health, Dr. C. C. Applewhite; Eye, Ear, Nose and 
Throat, Dr. W. L. Hughes. 

This was the last meeting of the society in 
Jackson until (September, as the July meeting will 
be in Vicksburg jointly with the Issaquena- 
Sharkey-Warren Counties Medical Society, and 
there will be no meeting in August. 

W. L. HUGHES, Secretary. 


Dr. Walter E. Johnston is home from Vander- 
bilt University, where he received his degree in 
medicine on June 10. He will enter the practice 
of his profession in Vicksburg and will be asso- 
ciated with his father, Dr. Sidney W. Johnston. 

The young medical man is the third member of I 
his immediate family to enter the profession, his 
brother, Dr. Hugh Johnston, now being at the 
Mayo Clinic. 


WOMAN’S AUXILIARY. 

At the May meeting of the Woman’s Auxiliary 
of the Issaquena-Sharkey-Warren Counties Medi- 
cal Society, held at the home of the President, 
Mrs. E. F. Howard, in response to an invitation 
from the Chamber of Commerce of Vicksburg, it 
was voted to co-operate with the other organiza- 
tions of the city in the annual “Clean up-Paint up” 
campaign. For this purpose a committee consist- 
ing of Mrs. M. H. Bell, Mrs. C. J. Edwards, Mrs. 

D. A. Pettit, Mrs. iS. W. Johnston, and Mrs. 

V. Bonelli, was appointed. 

Doyle E. Hinton, acting Executive Secretary of 
the National Tuberculosis Association, New York, 
and J. T. Savage, President of the Mississippi 
Tuberculosis Association, Jackson, wei'e present, 
and explained the work of the Tuberculosis Asso- 
ciation. The Auxiliary was asked to sponsor the 
raising of a four thousand dollar fund for the 
state and to take over the annual sale of Christmas I 
seals for the counties of Issaquena, Sharkey and || 
Warren. 

Mrs. M. H. Bell, Vicksburg, attended a special j| 
meeting of the Board of Directors of the Missis- i 
sippi Tuberculosis Association at the Edwards 
Hotel, Jackson, on June 17. She was accompanied 
by Mrs. E. F. Howard, President of the Woman’s 
Auxiliary. 

The Jackson meeting was addressed by Dr. 
Kendall Emerson, Managing Director of the ; 
National Tuberculosis Association, with headquar- 
ters in New York City, by Dr. Felix J. Underwood, i 
Executive Officer of the Mississippi State Board of j! 
Health, and by Dr. Henry Boswell, Superintendent I 
of the Mississippi State (Sanatorium and Pre- j 
Preventorium. Mr. J. T. Savage, of Jackson, i 
President of the Mississippi Association, presided. | 


Dr. Edwin Akin, Aberdeen, is the new resident j 
physician at the Vicksburg Hospital, succeeding ;| 
Dr. G. P. Sanderson, who has entered private ,| 
practice with offices in the First National Bank 
building. Dr. Akin received his medical degree 
from the University of Louisville following a medi- 
cal course at the University of Mississippi. 


Mississippi State Medical Association 


81 


EXTRACTS FROM THE MINUTES OF THE 
HOUSE OF DELEGATES OF THE MISSIS- 
SIPPI STATE MEDICAL ASSOCIATION. 

Report of Dr. C. W. Patterson, Rosedale, 

Vice-President. 

To the House of Delegates, Mississippi State 

Medical Association. 

Gentlemen: On August 21, 1930, following the 

request of Dr. E. F. Howard, President of the 
Mississippi State Medical Association, I attended a 
meeting of the officers of the Association at 
Jackson. 

After making a list of each non-member in the 
various counties and grouping them under the 
proper societies, I wrote the following members of 
the Delta Society before the October meeting and 
enclosed a copy of non-members with the request 
to assist in the work of organization by appealing 
to those who lived in their vicinity: Dr. H. T. 

Cummings, Pace, Boolivar County, Vice-President; 
Dr. G. M. Barnes, Belzoni; Dr. G. Y. Gillespie, 
Greenwood; Dr. W. A. Carpenter, Cleveland, and 
Dr. R. D. Dedwylder, County Health Officer. 

I also visited Dr. Cummings. I appealed to 
Councilor J. W. Lucas, Moorhead, to get all non- 
members in his county but received no reply and no 
non-member’s names. He was not at the Belzoni 
meeting. 

At the meeting in Belzoni, October 9, 1930, I 
collected from Dr. E. R. McLean and got the fol- 
lowing new members: Drs. Parnell, Pace and 

Wiggins, Cleveland. 

At this meeting I asked doctors from each town 
to see non-members in their vicinitiy, which they 
promised to do, but their promises were like pie 
crust — easily broken. 

On October 15, I gave Dr. L. B. Austin, Presi- 
dent of the Clarksdale and Six Counties Medical 
Society, a list of all non-members in those counties. 
I also asked the secretary of that society to assist. 

On November 5, I attended the meeting of the 
Clarksdale and Six Counties Medical Society and 
addressed them on “Organization.” At this meet- 
ing I talked to Dr. Brookshire and he paid his dues. 

Between November and March I appealed to the 
doctors individually and wrote many letters. 

By request of President Howard I attended a 
meeting of the Clarksdale and Six Counties Medi- 
cal Society on March 25, 1931, and received in- 
structions for future work. 

At a meeting of the Delta Medical Society on 
April 8, 1931, I made three separate talks on 


organization and suggested that each county Vice- 
President assist in the work. 

On April 15, I attended a meeting of the North 
Mississippi Medical Society at Holly Springs and 
made an address on “Organization.” I was in- 
formed by the Secretary that only 53 had paid 
from a list of 126 eligible for membership. I also 
learned from many new names had failed of 
mention at the business meeting, but were acted 
upon after my talk. 

I also gave a list of the non-members to several 
doctors at this meeting. 

Respectfully submitted, 

Charles W. Patterson. 

Report of Dr. L. L. Polk, Purvis, Vice-President. 

To the House of Delegates, Mississippi Medical 
Association. 

Gentlemen: 

So far as I can learn the office of Vice-President 
has been strictly one of honor. 

Our most active and efficient President, Dr. E. F. 
Howard, has sought to have the Vice-Presidents do 
some real constructive work in their own sections. 
My labors have been in the Seventh, Eighth, and 
Ninth Districts. I have endeavored to work with, 
and through, the Councilors of these Districts. Our 
efforts have been directed toward getting new 
members into the county societies, and to getting 
revised lists of memberships. This last has been 
rather difficult, but the several Councilors have 
done efficient work along this line, and I believe 
our lists are very nearly correct. 

Councilor J. W. D. Dicks, of the Eighth District, 
has been very active; and so has his district well 
organized. He deserves much credit for the work 
done. 

Councilor Dan Williams, of the Ninth District, 
has continued to keep his work up; so his district 
is well organized. 

Councilor Joe Green, of the .Seventh District, 
has not been on the job long, but ha v s been very 
active. 

Much work is needed to be done in the Seventh 
District, but owing to the sickness of my wife and 
myself lasting over a period of six months I could 
not give as much time to this district as it 
demanded. 

Dr. Green and I have co-operated perfectly in 
this work. We have written, ’phoned, and in every 
way urged the doctors to come into our society. 

Respectfully submitted, 


L. L. Polk. 


82 


Mississippi State Medical Association 


Report of Dr. T. M. Dye, Clarksdale, Secretary. 

To the House of Delegates, Mississippi State 
Medical Association. 

Gentlemen : 

Notwithstanding the state-wide economic de- 
pression the membership of the Association has 
decreased only about one hundred for the year. 
This splendid showing is due in large part to the 
activity of the President, who has shown an un- 
usual interest in organized medicine during his 
administration. 

During the year a charter was issued to the 
North Mississippi Society, composed of Benton, 
Lafayette, Marshall, Panola, Tippah, Union and 
Yalobusha Counties. 

Acting upon instructions of the House of Dele- 
gates the bond of the Treasurer was increased to 
fifteen thousand dollars. 

E. M. Gavin, Councilor of the Seventh District, 
resigned and President Howard appointed Joe E. 
Green, of Richton, to succeed him. 

Historian P. W. Rowland resigned and President 
Howard appointed J. iS. Ullman, Natchez, to suc- 
ceed him. 

Fraternally yours, 

T. M. Dye. 

Report of the Councilors. 

First District. 

The First District is organized into two active 
societies: the Clarksdale and Six Counties Medical 
Societiety and the Delta Medical Society. Each 
society embraces a large territory and a good 
sized membership and each holds semi-anuual 
meetings. Effort is being made through the two 
secretaries to hold a joint social meeting of the 
two societies during the summer. More frequent 
meetings are advisable. 

There are about two hundred and eighty eligible 
physicians and surgeons in the District. 

On May 1, the Clarksdale and Six Counties 
Society showed a paid-up membership of fifty-two: 
the Delta iSoeiety showed a paid-up membership of 
seventy-nine. Regardless of hard times, the gen- 
eral average in attendance, paid-up dues, and 
general interest manifested have bean excellent. 
The scientific programs have bean practical and 
interesting and freely discussed by members and 
visitors. No law suits pending to mar “status quo.” 
The morale is excellent and tha future bright. 

J. W. Lucas, Councilor. 


Second District. 

The Second Councilor District can report con- 
siderable progress. The North Mississippi Six 
Counties Medical Society, composed of the Coun- 
ties of Benton, Lafayette, Marshall, Tippah, 
Winona, and Yallobusha surrendered its charter 
as did the Panola County Medical Society, form- 
ing the North Mississippi Medical Society. This ! 
Society meets every three months with a fine at- 
tendance and much interest. 

The Tate County Medical (Society has nine 
members; one non-member. On account of con- 
tinued illness of the secretary, the usual number 
of meetings yearly — six — were not held. 

The DeSoto County Medical Society meets every 
three months, good interest and attendance; 
twelve members; one non-member. 

This County just recently suffered the loss of 
its oldest and best member, Dr. W. S. Weissinger. 

No call on medico-legal fund. I have endeavored 
to keep in touch with all matters in the District. 

L. L. Minor, Councilor. 

Third District. 

The Northeast Mississippi Thirteen Counties 
Medical Society has a membership to date of 139 
out of a possible 182. We are about 20 or 30 
members short from 1930. Our society meets every 
three months, or four times a year. We meet upon 
invitation from the towns in our territory. Our 
meetings are well attended and are profitable, we 
think. There have been no suits, as far as I know, 
brought against any member of our society. The 
last four meetings have been at Starkville, Aber- 
deen, Corinth and Houston. There is nothing else 
that I know might be presented to the House. 

W. M. Robertson, Councilor. 

Fourth District. 

There are 93 eligible members in the seven 
counties. There are 49 who have paid their dues 
to date. 

There were four regular meetings held in the 
past year with an average of 22 members present 
at each meeting. 

Eligible members Members 


Montgomery 

Carroll 

Webster 

Choctaw 

Grenada 

12 

8 

11 

7 

11 

7 

4 
3 

5 

8 
11 

Holmes 

18 

Attala ^ 

20 

7 


— 

— . 

Totals 

No losses. 

93 

49 


T. W. Holmes, Councilor. 


Mississippi State Medical Association 


83 


Fifth District. 

The activities of organized medicine in this Dis- 
trict are comprised in the work of two societies, 
the Central and the Issaquena-Sharkey-Warren. 
Claiborne County has an organization in name only. 
Two or three doctors get together just before the 
annual meeting of the State Association and elect 
themselves officers and delegates. Overtures have 
been made repeatedly to get Claiborne into either 
one of the two larger societies in the District, but 
thus far without avail. 

The Central, including the Counties of Hinds, 
Rankin, Madison, Yazoo, iSimpson and Scott, re- 
ports a paid-up membership on May 1, of 126 
members. Dr. C. L. Green is the President, 
Dr. W. L. Hughes is the Secretary. This society 
holds regular monthly meetings with an average 
attendance of about 60, and have not failed in 
many years to execute a pre-arranged program. A 
special feature of the meetings of this society is 
the conduct of a short clinic before the regular 
scientific program. Dues are $8.00 for the year. 
During the year, this society suffered the loss of 
four members by death — Drs. Galloway, Arm- 
strong, Basinger and Ross. Also, we have lost 
several members by removal. 

The Issaquena-Sharkey-Warren comprises the 
three counties hyphenated, and reported a paid-up 
membership of 35 on May 1. They suffered the 
loss of one member by death — Dr. J. P. O’Leary. 
This society meets monthly and never fails to carry 
out a scientific program. A special feature of this 
society is to have every member appear upon the 
scientific program at least once a year. Two joint 
meetings were held with the Fifth District Medical 
Society of Louisiana and one with the Central, 
during the year. Dr. J. B. Benton is the Presi- 
dent, and Dr. Leon S. Lippincott is the Secretary. 

D. W. Jones, Councilor. 

Sixth District. 

I want to apologize for work done the past two 
months, but I got out of bed to attend this meeting. 

I want to commend Dr. M. J. L. Hoye, Vice- 
President, for his good work in the membership 
drive. 

At the meeting of the East Mississippi Medical 
Society, the first of August, 1930, at the Patrons 
Union, we invited Scott County to meet with us 
and invited them to join with us, but they presented 
a list of a majority of doctors in Scott County 
asking to be admitted to the Central Medical 
Society. This was taken up at a meeting of the 
Council held in Jackson and their request granted. 


East Mississippi Medical Society is in good 
shape, holding regular meetings every other month 
and well attended. 

Kemper and Leake could do better and advise 
their coming in with the East Mississippi. 

Dr. Dudley Jones informs me that the suit, 
Martin vs. Hairston, has been settled. 

W. G. Gill, Councilor. 

Seventh District. 

Having been appointed to fill out the unexpired 
term of Dr. E. M. Gavin, resigned, I have not had 
much time to work. But with the help of our 
President, Dr. Howard, and Vice-President, Dr. 
Polk, some progress has been made. The Seventh 
District is composed of the South Mississippi Medi- 
cal Society, active, which has quarterly meetings 
that last from 2 P. M. to 9 P. M., and at which 
meetings there is splendid attendance, and well- 
balanced scientific programs rendered. The Clark- 
Wayne Society is inactive and at present we have 
a movement on foot to have Clark County join the 
East Mississippi Medical Society at Meridian and 
Wayne join the South Mississippi Medical Society. 

Only one damage suit has been filed and that 
was against Dr. Stroud at Mount Olive and I 
understand has been settled. Dr. T. Gandy, Royce; 
Dr. Robert Stewart, Poplarville, and Dr. George 
Mason, Lumberton, have been taken by death and 
our society as well as organized medicine suffered 
a distinct loss in the going of these three active 
young physicians. 

Harmony prevails in our ranks in the Seventh 
District. 

Joseph E. Green, Councilor. 

Eighth District. 

To the Council and House of Delegates, Missis- 
sippi State Medical Association. 

Gentlemen: 

The Eighth Councilor District consists of three 
medical societies — namely, the Tri-County Medical 
Society — embracing in its territory the counties of 
Copiah, Lincoln, Walthal, and Lawrence; the Pike 
County Medical Society, a one-county society; and 
the Homochitto Valley Medical Society, consisting 
of the counties of Adams, Amite, Jefferson, Frank- 
lin, and Wilkinson. 

The number of eligible physicians residing in 
the Eighth Councilor District is 126. The com- 
bined membership of the three medical societies 
is 102; the number of non-members is 24. The 
percentage of membership for this district is 80 
plus per cent. 


84 


Mississippi State Medical Association 


The membership by societies is as follows: 


Medical Society Members Honorary Total Non-members 

Tri-County 33 1 34 17 

Pike County 24 0 24 0 


Homochitto Valley.. 43 1 44 7 

The number of members and non-members of 
the three societies arranged by counties is as 


follows : 

County Members Non-members 

Copiah 9 10 

Lawrence 5 2 

Lincoln 14 4 

Walthal 6 1 

Pike 24 0 

Adams 24 0 

Amite 4 5 

Franklin 7 1 

Jefferson 1 4 1 

Wilkinson 5 0 


Analyzing the county statistics of membership, 
we find that in the Tri-County Medical Society, 
Walthal County leads with 85 plus per cent, 
Lincoln comes second with 77 plus per cent, Law- 
rence third with 71 plus per cent, and Copiah last 
with 46 plus per cent. Pike County Medical 
Society has 100 per cent membership. In the 
Homochitto Valley Medical Society, Adams and 
Wilkinson Counties lead with 100 per cent each, 
Franklin is second with 87 plus per cent, Jeffer- 
son third with 80 per cent, and Amite last with 
44 plus per cent. 

Since the last meeting of the State Association, 
the three societies have suffered a death loss of 
four members. During the year ending May, 1930, 
the societies of this district reported a combined 
membership of 93. Deducting our losses from 
death we show a net gain of thirteen members. 
This gain is probably a little larger if we deduct 
removals from the district. 

During the past year the Tri-County Medical 
Society held four meetings, one each quarter. The 
average attendance at these meetings was 25. The 
Pike County Medical Society held twelve meetings, 
one each month, with an average attendance of 18. 
The Homochitto Valley Medical Society held four 
meetings, one each quarter, with an average at- 
tendance of 16. Very interesting and instructive 
programs were arranged for these meetings. 

A vigorous campaign was put on to bring into 
organized medicine all eligible non-members in the 
district. The Vice-Presidents of the three societies 
were commissioned as recruiting officers in their 
respective counties. 


A list of the non-members in their respective 
counties was sent to them and they were urged to 
make a strenuous effort to bring these non-menr- 
bers in. They were advised to call on the Councilor 
for any aid they might need in order to get these 
non-members who are eligible into the medical 
societies. 

In order to aid the vice-presidents in this work, 
I addressed personal letters to every non-member 
in this district, inviting and urging them to come 
forward and identify themselves with organized 
medicine by joining one of the three medical 
societies. 

I believe this campaign has resulted in several 
new members being added to the medical societies 
of this district. 

With a view to increasing the interest in the 
societies and stimulating their growth, we organ- 
ized a joint meeting of the three societies in this 
district. We met in Brookhaven during the month 
of October, 1930. A very interesting program was 
arranged. The President and several of the other 
officers of the State Association were present at 
this meeting. We had an attendance of about 
seventy members. 

It was decided at this meeting to perpetuate 
the joint meeting of the societies, and a perma- 
nent organization was effected. A standing com- 
mittee, consisting of the presidents and secretaries 
of the three societies, was appointed to act with 
the Councilor of the district to arrange the de- 
tails for future joint meetings. Natchez was 
selected as the next place of meeting and October 
was designated as the time for the meeting. We 
are planning a splendid program for this meeting 
and expect to have a record-breaking attendance. 

It is our intention to make an aggressive cam- 
paign for new members and I hope that in the 
near future this district will be able . to show 
approximately 100 per cent membership. 

The economic depression prevailing during the 
past year has no doubt prevented a larger gain 
in membership. 

There have been no malpractice suits in this 
district brought to the attention of the Councilor 
during the past year. 

I believe a live, energetic program committee 
is essential for each society. Every program 
should be interesting and instructive. Round table 
discussion of clinical cases, I believe, to be more 
important than papers. I do not mean to infer 
that scientific papers are not important, but I 
would rather stress clinical case reports as proba- 
bly being of more interest to the general practi- 
tioner. Medical economics should receive more 


Mississippi State Medical Association 


85 


attention than we have been giving to this im- 
portant subject in the past. This subject should 
have a place on our programs. As this is a rather 
materialistic age in which we are living, men de- 
mand some material return for the money expended 
in dues. Unless we can give this return, we cannot 
expect to interest them in organized medicine. 
Medical ethics also should have a place in our 
programs and should be stressed. 

I would recommend that the medical societies 
endeavor to inculate a spirit of team-work and 
comradeship among their members, make the local 
medical society a militant organization, affording 
its members a means of improving themselves pro- 
fessionally and aiding them to solve the economic 
problems that confront our profession. 

J. W. D. Dicks, Councilor. 

Ninth District. 

The Harrison-Stone-Hancock Counties Medical 
Society continues to hold its regular meetings in 
the evening of the first Wednesday of each month. 
These meetings in the past year have been held 
at Biloxi, Gulfport, Pass Christian, and Bay St. 
Louis, with good attendance and interesting and 
instructive programs. 

The Jackson County Medical Society has been 
invited to join with the Harrison-Stone-Hancock 
Counties Medical Society. 

The Jackson County Medical Society meets 
regularly on the second Tuesday evening in March, 
June, September and December. 

Every physician in the county is a member in 
good standing except one. 

Daniel J. Wilson, Councilor. 

REPORT OF DELEGATE TO THE MEETING 
OF THE AMERICAN MEDICAL 
ASSOCIATION. 

Detroit, Michigan, June 23 to 27, 1930. 

To the President and House of Delegates, Missis- 
sippi State Medical Association. 

I attended the last meeting of the American 
Medical Association in Detroit as a delegate from 
the Mississippi State Medical Association. I have 
been requested by your President to present to you 
a report of the proceedings of the House of Dele- 
gates in an endeavor to bring into more intimate 
contact the association of our Society with the 
parent organization. As you are aware, the 
American Medical Association occupies a relation- 
ship to the various state organizations similar to 
that of the state organization to the various local 
or county societies. 


In the organization of the House of Delegates 
at its intial meeting one is struck at once by the 
rigorous scrutiny of the credentials of the dele- 
gates. No one is seated unless he can produce 
indisputable evidence of his appointment as a 
delegate or alternate. A number of members of 
the various state societies who desired to represent 
their societies in the absence of delegates were 
unhesitatingly refused admission to the House by 
the presiding officer. 

Following the seating of the delegates came first 
the address of the Speaker of the House, after 
which was the appointment by him of the various 
reference committees. The Speaker, Dr. F. C. 
Warnshuis, after welcoming the delegates to 
Michigan, of which State he is a resident, de- 
voted the most salient portions of his address to 
an explanation of the mode of procedure to be 
followed in the handling of the various matters, 
reports, resolutions, new business, etc., coming 
before the House. 

Next in order came the address of the retiring 
president, then that of Dr. Gerry Morgan, presi- 
dent-elect, followed by that of the secretary, and 
then the reports of the board of trustees and the 
various bureaus. 

Dr. Harris devoted his address in large measure 
to a plea, in an endeavor to forestall state medi- 
cine, for the various county societies throughout 
the nation to organize and incorporate for business 
purposes, medical centers owned and controlled by 
the medical profession, where all classes of persons 
who are unable to pay regular fees to their own 
physicians could secure the highest type of treat- 
ment at prices within their incomes. There is no 
question but that this is a real problem confronting 
the profession and one to which we should all give 
our most earnest thought and endeavor. Whether 
Di\ Harris’ method is the most feasible plan and 
one adapted to all sections one cannot say. He 
has given much thought and study to the subject 
and in our opinion it is well worthy of our serious 
consideration. It is a vital subject which will 
eventually affect each member of the medical pro- 
fession wherever he may be practicing. 

Dr. Morgan in his address paid particular atten- 
tion to the relation of the physician to the hos- 
pital from the standpoint of the pecuniary value 
of his services. This was stressed on account of the 
growing tendency of the public and insurance com- 
panies to assume that the payment of the hospital 
bill discharged all obligations for treatment in- 
cluding medical and surgical services rendered. 
To quote Dr. Morgan: “These services (the physi- 
cian’s) are his direct individual contribution to the 
patient receiving them, and as such they cannot 
be regarded as part of that which the hospital 


86 


Mississippi State Medical Association 


sells or gives away, according to its own corporate 
judgment.” 

The . Secretary’s report dealt with the member- 
ship of the Association and a plea for militant, 
co-ordinated, homogenous organization from top to 
bottom, or from national organization down to the 
individual member of each county society. This 
condition we feel can ultimately be attained by a 
well defined program carried out year by year, by 
the various state organizations. 

When one comes to review the report of the 
Board of Trustees one is brought to a full realiza- 
tion of the immensity of the work that is being 
accomplished by the present organization. 

The publication of the Journal of the American 
Medical Association, Archives of Neurology and 
Psychiatry, Archives of Dermatology and Syphil- 
ology, Archives of Pathology, Archives of Sur- 
gery, Archives of Ophthalmology, Archives of 
Otolaryngology, Archives of Internal Medicine, 
American Journal of Diseases of Children, and the 
Quarterly Cumulative Index, have all been kept 
upon the highest plane of scientific medicine, and 
while some have been published at a financial loss, 
we feel that from the standpoint of advanced and 
scientific medicine they are well worth the expense. 

The library has grown from year to year and 
has been so conducted as to put its facilities at 
the disposal of any one of us. During 1929, 
2000 library packages were supplied, approxi- 
mately 5000 periodicals were loaned. To any 
physician desiring to take advantage of its serv- 
ices it offers a fertile source of information on any 
medical subject. 

It is hardly necessary to mention the great work 
being accomplished by the Council on Pharmacy 
and Chemistry, in protecting the profession and 
public from exploitation. All of the new drugs 
and remedies are thoroughly investigated by it 
and a report rendered the profession through the 
columns of the Journal. 

Because of the great public interest in foods 
and the exploitation of food products by commer- 
cial interests, the Council investigates thoroughly 
these products, and keeps us informed as to their 
legitimate worth. 

The Council and Physical Therapy has sought 
through the columns of the Journal and by radio 
broadcasting to keep us informed and to educate 
the public as to the relative merits of the various 
physio-therapy agents. 

The field of physio-therapy is comparatively 
new. Many of the methods are empiric in char- 


acter, requiring all the closer scrutiny on the part ; 
of the Council. For this reason this phase of j 
work has been placed under several different com- j 
mittees, vix., roentgen-ray, education, radium, 
advertising, scientific research, nomenclature and 
definition, and standardization. 

The Bureau of Legal Medicine and Legislation 
is constantly watching legislative developments I: 
both state and national and uses its influence to ! 
the end that legislation affecting the profession 
and public be of such a character as to be for 
their best interests. There was brought strongly 
to the attention of the House the present attitude 
of the Government toward the hospitalization and 
treatment of conditions and diseases not originat- 
ing in the service and having no connection there- , 
with. To quote from its report: “Now, however, 

the Government is constructing numerous hospi- 
tals and providing many beds solely to accommo- 
date persons suffering from diseases and injuries 
in no way connected with the service. The ex- 
cessive demands that have heretofore been made 
for such socialistic service from the Federal 
Government have been and are leading to still 
further demands, and the end is not yet in sight. 
The situation is grave.” 

This bureau functions in every field of legal 
endeavor where its services will serve to protect 
the interests of the profession and public. 

The duties of the Bureau of Health and Public 
Instruction are mainly educational in character, i 
consisting of addresses, radio talks on subjects of 
public interest, and the distribution of literature 
dealing with health, hygiene, etc. 

Regarding the scope of work done by the Ameri- 
can Medical Association I can do no better than 
to quote two concluding paragraphs from the re- 
port of the trustees: 

“Apparently many members do not have any j 
genuine appreciation of the scope of the work of j 
the Association. Many seem to be unaware that 
any activities are engaged in except those necessary 
for the production of the Journal; others appear 
to believe that the Association is concerned only 
with the publication of its periodicals. 

The councils of the Association are constantly 
carrying on constructive and significant work in 
the promotion of scientific medicine; the Associ- 
ation’s bureaus deal with matters pertaining to 
the interests of the medical profession and the 
public welfare. In addition they constitute a 
service department through which information is 


Mississippi State Medical Association 


87 


continually disseminated to the officers of compo- 
nent and constituent medical societies and to 
individual members of the Association as well as 
to the general public.” 

The Judicial Council in its report to the House 
of Delegates stated that the work of this body 
was becoming increasingly heavier because of the 
developmments in industrial medicine, the activi- 
ties of corporations in medical fields, the expan- 
sion of public health programs, especially those 
of unofficial agencies, the organization of so-called 
hospital associations and co-operative diagnostic 
laboratories, the creation of funds and foundations 
concerned in some manner with medical practice 
or public health, the working of compensation 
laws, and many other factors which have given 
rise to many new questions and have produced 
many perplexing problems of which final solution 
is not easily possible. This Council is doing a 
constructive work and should be given every assist- 
ance possible towards the working out of the 
problems presented to it. 

The Council on Medical Education and Hospi- 
tals has been directly instrumental, you might say, 
has been the main factor in the elevation of the 
standards of medical education, and the placing of 
our medical schools upon a high scientific basis. 

The following quotation gives a brief resume of 
the scope of the work embraced: “During the last 

twenty-five years the Council’s field of service has 
been gradually extended until now it has to do 
with the four following departments of medical 
practice. 

1. Medical education, including premedical, un- 
dergraduate and graduate medical education. It 
also includes medical licensure, as the standards 
of licensure depend considerably upon the stand- 
ards put into effect by the medical schools. 

2. Hospitals, including (a) hospitals of from 
seven beds up which are considered worthy of 
being named in the ‘Hospital Register’; (b) those 
sufficiently developed educationally to deserve ap- 
proval for the training of interns, and (c) those 
worthy of approval for higher internships, or 
residencies, in the specialties. 

3. Clinical Laboratories. The Council’s work 
in this field was authorized by the House of Dele- 


gates in 1923 following simultaneous but inde- 
pendent petitions from (a) the American Chemical 
Society, and (b) the Section on Pathology and 
Physiology of the American Medical Association, 
requesting that after due investigation, a list of 
clinical laboratories deemed worthy of approval be 
established. 

4. Laboratories of Radiology. In 1928 the sec- 
tion on Radiology of the Illinois State Medical 
Society petitioned the House of Delegates to have 
the Council’s duty of supervising clinical labora- 
tories extended to include also the laboratories of 
radiology. In both these fields the supervision in- 
cluded not only private laboratories but also the 
departments of hospitals.” 

In the time at my disposal I have necessarily 
had to be brief and give a cursory review of 
what struck me as the most salient features 
brought out during the meeting. One is im- 
pressed by the magnitude of the work that is being 
accomplished, and it is brought definitely home to 
one that every citizen and every physician is being 
affected by the work of this organization, much of 
which is done by men without renumeration with 
a whole souled devotion to duty in order to make 
this a better world in which to live. 

There is one observation that I would like to 
make and that is that, if some means could be de- 
vised by which our organization could keep an able 
representative in the House of Delegates for a 
longer period of time his influence would be much 
enhanced and we would be the gainers thereby. 

One is struck by what is accomplished in an 
assembly of this character by one who is familiar 
with the routine and conversant with the guiding 
hands in contradistinction to what one accom- 
plishes who is new to the business and who is a 
stranger amongst strangers. 

Wo look upon being appointed as a delegate as 
an honor, which it is, but it is also a position of 
trust and carries with it an obligation of work to 
be done, which is difficult of accomplishment under 
our present system. 

Hugh A. Gamble. 

Fraternal Delegate. 

A pleasing feature of the session was the 
official reception and introduction of Dr. Randolph 


88 


Mississippi State Medical Association 


Lyons, New Orleans, Fraternal Delegate from the 
Louisiana .State Medical Society. Dr. Lyons gra- 
ciously extended the greetings of the Louisiana 
Society to the Mississippi Association. 

Medical School. 

John C. Culley presented the following resolu- 
tion relative to the University Medical School, 
which was adopted: 

Articles of Resolution. 

Whereas, In the course of the past year of un- 
settled political conditions within the State of 
Mississippi, whereby the University of Mississippi 
School of Medicine has been, and still is, placed 
in jeopardy; and, 

Whereas, The American Medical Association, 
through its respective officers, Doctor N. P. Cald- 
well, Secretary of the Council on Medical Education 
and Hospitals, and Doctor Fred C. Zapffe, Secre- 
tary of the Association of American Medical 
Colleges — have been so wise, and considerate and 
judicious in their every act in passing on the 
status and rating of the University of Mississippi 
School of Medicine; have worked unceasingly and 
unselfishly with the officers of our Medical School 
and this Association to keep this, Mississippi’s only 
Medical School, intact, operative, and of Class-A 
rating; and 

Whereas, Doctor P. L. Mull, Dean of the Uni- 
versity of Mississippi School of Medicine, the 
faculty members of our Medical School, friends 
and alumni throughout the State and elsewhere 
have loyally and unselfishly given unreservedly of 
their time, resources, influence and energy to the 
welfare and protection of our State Medical .School, 
despite adverse conditions and depleted treasuries; 
now, therefore. 

Be it Resolved: 

1. That we, in regular session assembled, as 
the State Medical Association of Mississippi, 
uanimously express our gratitude, indebtedness and 
high esteem to Doctor N. P. Caldwell, Secretary 
of the Council on Medical Education, Doctor Fred 
C. Zapffe, Secretary of the Association of Ameri- 
can Medical Colleges, Doctor P. L. Mull, Dean of 
the University of Mississippi School of Medicine, 


the faculty of the University of Mississippi School 
of Medicine and those others instrumental in with- 
standing and combatting the destructive influences 
which came so near destroying our Medical School 
and bringing its good name, excellent record and 
enviable reputation of those many years into dis- 
repute and extinction; and 

2. That these resolutions be forwarded respect- 
ively to Doctors Caldwell, Zapffe, Dean Mull and 
the faculty of the University of Mississippi Medi- 
cal .School; that a copy be given to publication 
and a copy hereof be spread on the records of 
this Association. 

Edley H. Jones introduced the following pro- 
posed changes in the Constitution and By-Laws: 
Constitutional change: Article VI., Sec. 1, insert 

after the word “Treasurer” “a Sergeant-at-Arms.” 
Sec. 2, delete the word “and” after President-Elect 
and add “and Sergeant-at-Arms” after “Vice- 
Presidents.” By-Law changes : Amend Chapter VI., 
Sec. 2, by inserting after “Treasurer” “three 
names for Sergeant-at-Arms.” Amend Chapter 
VII., by adding section 6 as follows: The duties 

of the Sergeant-at-Arms shall be to aid and assist 
the President in preserving order, seating dele- 
gates properly, and any other duties prescribed by 
the President. He shall be authorized to appoint 
as many assistant .Sergeants-at-Arms as may be 
necessary to aid him in the proper performance of 
his duties. 

Honorary Members. 

Dan J. Williams, on behalf of the Harrison- 
Stone-Hancock County Society, proposed the fol- 
lowing members for honorary membership and 
they were unanimously elected: D. G. Mohler, 
Gulfport; J. D. Wilkerson, Gulfport; G. A. Mc- 
Henry, McHenry. 

O. N. Arrington, on behalf of the Tri-County 
Society, presented the name of J. M. Catchings, 
Hazelhurst, for honorary membership, and he was 
unanimously elected. 

C. W. Patterson, acting for the Delta Society, 
offered the name of L. B. Sparkman, of Rosedale, 
for honorary membership, and he was unanimously 
elected. 

H. F. Garrison, on behalf of the Central Medical 
Society, presented the name of B. L. Culley, of 


Mississippi State Medical Association 


89 


Jackson, for honorary membership, and he was 
unanimously elected. 

Meet in Jackson in 1932. 

After a spirited contest Jackson was selected 
as the meeting place for 1932. 

H. A. Gamble moved that the Secretary com- 
municate the sympathy of the Association to the 
families of Drs. Lynch and Stucky, who were so 
tragically killed a day or two before. This was 
unanimously adopted. 

Appreciation. 

W. H. Frizell offered the following resolution 
of appreciation, which was unanimously adopted: 
Moved by the Mississippi State Association that 
its deep appreciation be expressed for the many 
courtesies shown by the Central Medical Society, 
the citizens of the city of Jackson, the manage- 
ment of the Edwards Hotel and by the press of 
the city of Jackson and reporters of Southern 
daily papers, during this session in the city of 
Jackson. 

Be it further moved, that we express our hearty 
appreciation for active and vigorous efforts of our 
President, Dr. E. F. Howard, for his constructive 
administration, and the efficient manner in which 
he has presided over its deliberations. 

J. S. Ullman, 

W. L. Little, 

W. H. Frizell. 

A motion offered by W. G. Gill was adopted to 
the effect that any member of the Association 
making examination for life insurance for any of 
the old line companies for a fee of less than $5.00 
was liable to expulsion from the Association. 

Budget and Finance. 

The Committee on Budget and Finance reported 
as follows through W. L. Little, which report was 
adopted : 

To the House of Delegates. 

Gentlemen : 

Your Committee on Budget and Finance has 
audited and approved the financial reports of the 
Treasurer and the Secretary. We reeommend the 
following budget for the year 1931-32: 


President’s Expense Account $ 100.00 

Secretary’s Salary 500.00 

Secretary’s Expense Account 100.00 

Editor’s Expense Account 300.00 

Historian’s Expense Account 100.00 

Council’s Expense Account 100.00 

N. O. Medical & Surgical Journal 1,000.00 

Transactions 200.00 

Expense Annual Meeting 300.00 

Incidentals : 50.00 


Total $2,750.00 

We recommend that the following bills be 

allowed : 

President’s Expense Account $ 100.00 

Vice-President Hoye Expense Account .... 37.14 

Vice-President Patterson Expense 

Account 50.00 

Vice-President Polk Expense Account 17.85 

Councilor Lucas Expense Account 12.35 

Councilor Minor Expense Account 10.35 

Councilor Jones Expense Account 27.05 

Councilor Gill Expense Account 7.47 

Councilor Green Expense Account 7.20 

Councilor Williams Expense Account .... 17.65 


W. L. Little, 

S. E. Eason, 

D. E. Montgomery. 

Report of the Council. 

Since adjournment of the State Association, the 
Council has held one semi-official meeting, at Jack- 
son, August 21, 1930. President Howard had 
requested the Council to meet with other officials 
of the Association for a round-table discussion of 
matters of organization. Williams, Robertson, 
Gill, Lucas, and Jones attended this meeting, along 
with President Howard, President-elect John C. 
Culley, Secretary T. M. Dye, Vice-Presidents 
Hoye, Patterson, and Polk, and Leon S. Lippin- 
cott, Editor of the Journal. The Councilors were 
admonished by the President of their duty as 
organizers of the Association membership, and an 
intensive campaign projected with the object of 
bringing into the membership every eligible physi- 
cian within its bounds. 

After adjournment of this meeting, the Council 
went into executive session. 

Councilor Gill presented the signed request from 
a majority of the physicians of Scott County ask- 


90 


Mississippi State Medical Association 


ing that this county be transferred to the Fifth 
District with membership in the Central Medical 
Society. The request was approved, and the Secre- 
tary of the Council was instructed to take up the 
Charter of the Scott County Medical Society, and 
merge the same into the Central Medical Society. 

A like request was submitted by Councilor 
Minor, in writing, for Panola County, requesting 
that this county be allowed to come into the North 
Mississippi Six County Medical Society, and that 
the name of this (Society be changed to the North 
Mississippi Medical Society. The request was 
approved and Councilor Minor was instructed to 
take up the Charter of the Panola County Medi- 
cal Society and merge the same as requested into 
the North Mississippi Medical Society, securing a 
new charter. Secretary Dye was requested to 
again remind the local societies that dues must be 
paid by February 1. Failure of the Secretary of 
a local society to file his report by February 1, 
automatically suspends that society from member- 
ship until such report is filed, and the members 
thereof would be ineligible for defense by the 
Council during that interval. It is urged that 
dues be collected before January 1, as far as 
possible. 

Secretary Dye was requested to send a list of 
physicians in each county who are not members 
of the Association to the respective Councilors 
immediately after receiving these reports from the 
Secretaries. 

The Council approved defense of the law-suit 
of J. H. (Smith vs. R. A. Clanton, et al., and 
ordered a check issued for attorney’s fee in this 
case. In the case of Ira Martin vs. Dr. S. H. 
Hairston, Councilor Gill was instructed to look 
into this matter, the plaintiff in this case having 
died since the suit was filed. 

Council adjourned to meet in May at the regular 
Convention. 

Since that date, Councilor Gavin has resigned, 
and Dr. Joseph E. Green, of Richton, has been 
appointed to fill out the unexpired term. Several 
law-suits have been filed against members of the 
Association and the Council is taking care of their 
defense; disposition of such cases will be reported 
later. 

May 12, 1931. 


The Council met on call of the Chairman in 
Room 223, Edwards House. Present all of the 
Councilors. 

Each Councilor presented a written report of 
the conditions of affairs in his district. Coun- 
cilor Lucas reported that there was nothing in his 
district requiring attention at this meeting. Coun- 
cilor Minor reported that there was nothing in his 
district requiring attention except confirmation of 
the action of the executive committee whereby the 
name of the North Mississippi Six Counties Medi- 
cal Society was changed to the North Mississippi 
Medical Society, with the following counties com- 
prised therein: Benton, Lafayette, Marshall, Tip- 
pah, Union, Yallobusha, and Panola. The Councilor 
hopes to get into this Society the counties of 
Tate and DeSoto, where the work has not been to 
his satisfaction. Councilor Robertson reported 
that there was nothing in his district requiring 
attention. Councilor Holmes made the same re- 
port for the Fourth District. Councilor Jones 
made the same report except that the law-suit of 
Mrs. Brown vs. Dr. J. M. Ware, is still pending 
in the courts. Approval of the defense in this case 
had already been given by the executive commit- 
tee. Sixth district, Dr. Gill reported nothing re- 
quiring attention except final order for the issuance 
of a check to Hon. V. B. M. Miller for services in 
the case of Martin vs. Hairston. This was done, 
and check issued accordingly. Dr. Green filed a 
request to transfer Clark County to the East Mis- 
sissippi Medical Society and asked permission for 
Wayne County to be transferred to the South Mis- 
sissippi Medical Society. He was instructed to se- 
cure a written request from the majority cf the 
doctors, members of the Association, in each county, 
and file same with the executive committee. Dr. 
Green reported one law-suit wherein Dr. W. F. 
Stroud was sued. It appeared that a druggist in 
the employ of Dr. Stroud filled the prescription 
complained by the woman for some other doctor. 
Therefore, the Council construed that there was no 
charge against Dr. (Stroud’s professional standing 
or integrity as a physician, even though he was 
as owner of the drug store, legally responsible for 
the acts of the druggist in his employ. The Coun- 
cil has repeatedly ruled that the Medico-Legal Fund 
is for the protection of the members of the Associ- 
ation, in their professional capacity. Matters of 
business should be covered by other insurance. 


Mississippi State Medical Association 


91 


The Secretary of the Council was instructed to 
again call attention of the members of the Associ- 
ation to the procedure required when asking for 
defense by the Association. Chapter 14 of the 
By-Laws explains this in detail. Briefly summar- 
ized, it is as follows: 1. Immediately confer with 

your Councilor, as to employment of attorney. 2. 
Present your case in writing; that is, a copy of 
plaintiff’s declaration; and your reply thereto; a 
statement from your County Committee on Medical 
Defense, which committee is composed of your Sec- 
retary, your Councilor, and the member of the 
County Society. Incidentally, the Secretary must 
certify to the time of payment of your dues. If 
the local committee approves the defense, your 
Councilor will forward the papers to the Secretary 
of the Executive Committee of the Council, who 
will forward same, if in due form, tto the two 
other members of the Executive Committee. If 
the Executive Committee approve the defense, your 
tee to order check issued for attorney’s fees without 
approval of the entire Council. 

DR. G. W. BARLOW. 

Dr. G. W. Barlow of Lake, Scott County, died 
suddenly at his home on May 14. On that day Dr. 
Barlow had been attending to his practice as usual 
and had returned to his home, when he was taken 
ill, complained of pain in his head, and died of 
apoplexy in less than an hour. 

Dr. Barlow was born at Harrisville, iSimpson 
County, March 7, 1868. After finishing high school, 
he entered Louisville Medical College, where he 
was graduated in 1889. During the same year he 
passed the State Board examinations and began to 
practice his profession in his native community. 
Here he remained for 24 years. In 1913, he moved 
to Star, Rankin County, and practiced there until 
1930 when he moved to Lake. He was of the old 
school of “country doctors,” who never knew tire 
or impatience in administering to his fellowmen. 
He was loved and trusted by everyone who knew 
him and will be sadly missed. 

Survivors are his widow, Mrs. Mattie Barlow, 
five sons, Billy, and Royce of Star, Jan and Walter 
of Jackson, and Tom of New Orleans, and two 
daughters, Miss Lucille of Waterproof, La., and 
Mrs. W. C. Cates of Converse, La. 


GRENADA COUNTY. 

There is little of personal nature to report for 
Grenada County. Our doctors are well and active 
with routine duties. A fine fraternal spirit exists 
among us and we have one hundred per cent mem- 
bership in our local society. 

We are fully behind our new President and want 
to help him to have a good year. 

Our membership will be interested to know that 
our esteemed Ex-President Dr. J. W. Young, is in 
good general health and though unable to get about 
is still keenly interested in everything medical. 

T. J. BROWN, County Editor. 


ISSAQUENAhSHARKEY-WARREN COUNTIES 
MEDICAL SOCIETY. 

A joint meeting of Issaquena-Sharkey-Warren 
Counties Medical Society and the Fifth District 
Medical Society of Louisiana was held at the St. 
Francis’ Sanitarium, Monroe, on Tuesday, June 16. 
Approximately one-half of the entire memmbership 
of the Mississippi Society was present. 

A fine banquet followed by an excellent scientific 
program and special entertainment features made 
up a most pleasant and profitable meeting. 

A return joint meeting will be held in Vicksburg 
in December with the Issaquena-Sharkey-Warren 
Counties Society as host. 

The next meeting, a joint gathering with the 
Central Medical Society, will be held in Vicksburg 
on Tuesday, July 14, at 7 P. M. The Central Medi- 
cal Society will furnish the scientific program. 


HONOR ROLL FOR JULY. 

J. S. Ullman, T. M. Dye, F. J. Underwood, J. H. 
Newcomb, J. M. Acker, T. L. Bennett, A. H. Little, 
Cummings H. McCall, W. L. Hughes, W. C. Pool, 
C. A. Pender, L. Wallin, F. P. Durfey, E. B. Burns, 
W. H. Frizell, L. J. Rutledge, M. L. Montgomery, 

C. W. Patterson, G. S. Bryan, K. P. McRae, W. H. 
Curry, R. P. Donaldson, R. B. Cunningham, C. M. 
Coker, R. M. Stephenson, W. L. Little, T. J. Brown, 

D. W. Jones. 

The above co-operated in the preparation of the 
news section for this month. Your editors thank 


you. 


BOOK REVIEWS 


The Chest in Children: By E. Gordon Stoloff, 

M. D. Paul B. Hoeber, Inc. 1930. Annals of 
Roentgenology Vol. XII. pp. 432. 

This large volume contains very beautiful illus- 
trations of chest radiographs with descriptive 
text and in many instances diagramatic sketches. 
Suggestions for diagnosis are very clearly set 
forth, and the anatomical as well as developmental 
aspects of certain structures such as thymus 
gland are described. 

This book should be a very valuable addition 
to the practitioners pediatric library. 

L. Von Meysenbug, M. D. 


Clinical Nutrition and Feeding in Infancy and 
Childhood: By I. Newton Kugelmass, M. D., 

Ph. D., Sc. D. Philadelphia. J. B. Lippin- 
cott Company. 1930. pp. 345. 

The purpose of this book is to supply the general 
practitioner with information concerning the 
etiology, diagnosis and treatment of the problems 
of pediatrics involving nutrition. It comprises 
modern contributions applicable throughout growth 
from the antenatal period to infancy and from 
early childhood to pubescence in the cause and pre- 
vention of disease, maintenance of health, and 
effective treatment of disease, for uninterrupted 
growth and development. 

While the title of this book leads one to believe 
that it deals only with feeding during infancy 
and childhood, it goes further and takes up blood 
disease and the infectious diseases. 

The illustrations are good and there are refer- 
ence to the literature throughout the book. 

It is not recommended as a text book for stu- 
dents, but should be handy for the genereal prac- 
titioner. 

L. Von IVSeysenbug, M. D. 


The Physics of X-Ray Therapy: By W. V. May- 

neord, M. Sc. Columbus, Ohio. Hugh A. 
Lound. 1931. pp. 177. 

This small book contains seven chapters and one 
hundred and seventy-seven pages, with one hun- 
dred and six illustrations. 

We recommend this book to all radiologists who 
are not well informed on the physics of roentgen- 
ray therapy. Too many use the roentgen-ray em- 
pirically in the treatment of disease, and many bad 
results are obtained for this reason. The author 


clearly explains the modern use of physical factors 
in the scientific application of the roentgen-ray. 

Leon J. Menville, M. D. 


Practical Radiation Therapy: By Ira I. Kaplan, 

B. S., M. D. Philadelphia, W. B. Saunders Co. 
1931. pp. 354. 

The author has had a great deal of experience 
in the use of radium and roentgen-ray in the treat- 
ment of disease Some 2,000 patients is referred 
to him annually for radiation therapy. 

We are impressed with his experience that small 
doses of heavily filtered radium applied over a 
long period of time is more efficacious than large 
doses for a short period. This has been our experi- 
ence and we believe that the pendulum is slowly 
but surely swinging in this direction. 

The first chapter of this book contains a brief 
but interesting historical description of the dis- 
covery of the roentgen-ray and radium. 

Beautiful illustrations accompanies the text and 
adds n1uch to the interest of this book which is a 
practical one, and contains valuable information 
to the radiologist who will find it very useful in 
his practice. 

Leon J. Menville, M. D. 


Year Book of General Surgery: Ed. by E. A. 

Graham, A. B., M. D. Chicago, Year Book 
Publishers. 1930. pp. 847. 

Following the custom of previous years, this 
volume gives in abstracted form the annual review 
of the surgical literature of the world, laying 
stress in many articles of particular interest which 
have been published during the year. 

Among these is the review of many articles in 
anesthesia with special emphasis upon the sub- 
stances relied upon for the production of full 
surgical anesthesia, Several articles dealing with 
some of the casualties following their use are also 
detailed. 

The subjects of hyperparathyroidism and sympa- 
thectomy in circulatory diseases of the extremity, 
as well as the surgical application of therapeutic 
venous obstruction are extensively discussed. 

The entire book is not only easily readable, 
instructive and practical, but also gives an 
authoritative answer to the salient practical 
points of current surgical progress in a condensed 
and easily obtainable way. 

Paul G. Lacroix, M. D. 


Book Reviews 


93 


Cerebrospinal Fluid, in Health and Disease: By 

Abraham Levinson, B. S., M. D. 3rd Edition. 
St. Louis, C. V. Mosby Co. 1929. pp. 386. 

This is the third edition of another note- 
worthy contribution on a special subject from the 
pediatrists. Logically presented, the first chapter 
consists of the hstiory of cerebrospinal fluid. 
Herein we learn that Hippocrates tapped the 
ventricles in hydrocephalus, that Herophilus dis- 
covered the fourth ventricle, and that the versatile 
Leonardo da Vinci concerned himself with the 
third circulation. Two of his cartoons are repro- 
duced. Touched upon are the discoveries or works 
of Hemesius, Galen, Glisson, Weil, Haller, Cotugna, 
Magendie, Schmidt, Corning, Wynter, Morton, 
Quincke, Middeldorpf. The chapters that follow 
consist of a general review garnised by the 
author’s own observations concerning the anatomy, 
chemistry, physiology and pathology of the cere- 
brospinal fluid. It is intelligently indexed and 
should be extremely worth while for rapid 
reference. 

Maurice Sullivan, M. D. 


The Centennial History of the Tennessee State 
Medical Association: Edited by Philip M. 

Hamer. Nashville, Tennessee State Medical 
Association. 1930. pp. 580. 

Lately there has been an epidemic of state 
medical society histories. This is just another one, 
over which it is difficult to become very excited 
unless you are particularly interested in Tennessee. 
One chapter, however, is of general interest. It 
is the chapter on Medical Education by Otis Warr. 
He describes the evolution of medical education in 
the state, which according to Mr. Flexner, “At one 
time harbored more low-grade medical schools than 
any other Southern state.” Eighteen medical 
schools were founded. Most of them were short- 
lived. The Memphis Medical College, the Botanico- 
Medical College, the Nashville Medical College, 
the Shelby Medical College, the Memphis Hospital 
Medical College, the University of Tennessee, The 
Chattanooga Medical College, the Tennessee Medical 
College, the Sewanee Mediical College, the College 
of Physicians and Burgeons, the Meharry Medical 
College, the Hannibal Medical College, the Chatta- 
nooga National Medical College, the Knoxville 
Medical College, the University of West Tennessee 
College of Medicine and Surgery, have given way 
to three institutions, viz: University of Tennessee, 
Vanderbilt and Meharry (for negroes). How and 
why this chaotic multiplicity of schools, what 
caused each to fail or to merge w'ith another, why 
Cornelius Vanderbilt made possible the establish- 
ment of one of the South’s greatest institutions, 


is all told so well by Dr. Warr that he steals the 
book. 

Maurice Sullivan, M: D. 


Diagnosis and Treatment of Brain Tumors: By 

Ernest iSachs, M. D., A. B. St. Louis, C. V. 

Mosby Co. 1931. pp. 396. 

The work is written by a man who is both a 
neurologist and a neurosurgeon, which fact is well 
exemplified throughout the entire book. In reading 
the book one is impressed with the clearness in 
which the various subjects are presented and the 
logic which the author has used in all of his 
assertions. The entire work represents largely the 
author’s own experience, which has been very ex- 
tensive, and points are well illustrated by represen- 
tative cases together with operative findings. The 
first chapter on surgical anatomy and physiology is 
excellently written, and it would be well worth the 
time of any physician to read it carefully. A 
large portion of the chapter on methods of ex- 
amination deals with roentgen-ray examination in 
which many characteristic and illustrative roent- 
genograms are shown. The author, however, feels 
and emphasizes that laboratory methods of diag- 
nosis are of much less significance in the diagnosis 
of brain tumors than are the clinical history and 
findings. In the chapter on symptoms and signs 
of increased intracranial pressure the original color 
paintings of changes in the eyegrounds are ex- 
tremely valuable. The entire work, however, is 
profusely illustrated, there being two hundred and 
eighteen illustrations, all of which are well done. 
The chapter on technic is especially clear and well 
illustrated from the set-up in the operating room 
to the various steps in the operative procedure. 

One can without hesitation say that this is un- 
doubtedly the best work of its kind in the English 
language and should be of value to any physician, 
even though he is not especially interested in 
neurosurgery. 

Alton Ochsner, M. D. 


Studies in Urology: From the Cornell Univer- 

sity Dept, of Urology, author. 1930. pp. 101. 

A review of the October, 1930, number of the 
Cornell University bulletin in which is reported 
the studies from the department of urology re- 
veals the excellence of the work that comes from 
that particular department of the school. 

It contains complete and often well illustrated 
articles on practically every condition, both surgi- 
cal and otherwise, that is encountered in the 
practice of uruology, and written by such eminent 
authorities as Keyes, McLellan, Stevens, Barringer, 
Jeck, Munch, Wehrbein and Campbell. 


94 


Book Reviews 


A careful study of this volume is. of equal value 
as a study of any of the modern published text 
books on urology, and perhaps even more so, due 
to the fact that it brings to the profession the 
latest word in that specialty. 

W. A. Reed, M. D. 


Hemorrhoids : The Injection Treatment and Pru- 
ritus Ani: By Lawrence Goldbacher, M. D. 

2nd Rev. Ed. Philadelphia, F. A. Davis Co. 
1931. pp. 207. 

This book outlines the author’s plan of treating 
hemorrhoids by the injection of 5 per cent phenol 
in cottonseed oil. The surprising thing about this 
treatment is the very large dose he uses at an 
injection. “At various times he (the author) has 
injected as much as 20 cubic centimeters of 5 per 
cent phenolized oil at one treatment (divided into 
two injections of 10 cubic centimeters each, at 
different sites.)”. 

The book is neatly arranged and printed, and 
plentifully illustrated, but too much space is wasted 
in trying to fill up its 207 pages. 

Maurice Lescale, M. D. 


Primary Syphilis in the Female: By Thomas A. 

Davies, M. D. (Lond.), London, Oxford Univ. 

Press. 1931. pp. 103. 

A most complete resume of the type, location 
and incidence of the primary luetic lesions found 
in the female. Great stress is placed on the 
frequency of the primary lesions of the cervix 
uteri, which is so often overlooked. 

He well points out the rarity of the typical 
chancre and the great necessity of the use of the 
dark field as a diagnostic measure. 

This little book is of inestimable value to every 
venereologist as well as gynecologist. 

Monroe Wolf. M. D. 


Practical Dietetics for Adults and Children in 
Health and Disease: By Sanford Blum, A. B., 
M. S., M. D. 4th Rev. & Enl. Ed. Philadel- 
phia, F. A. Davis Co. 1931. pp. 380. 

Another book on dietetics, of which there seemed 
already to be an abundant supply. The present 
work has the advantage of simplicity and clearness. 
The arrangement, alphabetically, also renders 
reference easy and rapid. The recommendations 
for diets are well thought out and based upon 
authoritative standards. The fact that there is 
no lengthy or elaborate discussion of the diseases 
for which the diets are suggested may be looked 
upon either as an advantage or as a disadvantage, 
according to the purpose to which the book is to 
be applied. 

I. I. Lemann, M. D. 


Collected Papers, 190J+-1929: By Edwin Beer, 

M. D. New York, Paul B. Hoeber, Inc. 1931. 
pp. 827. 

This volume consists of most of the medical 
publications of the author that have appeared dur- 
ing the past twenty-five years. The papers are 
grouped chronologically and according to subject- 
matter — gastro-intestinal, liver, kidney, bladder, 
ureters, prostate, spleen and spinal cord. 

Each paper is easily readable, scientifically dis 
cussed and of practical value, giving the reader ; 
the benenfit of the author’s vast experience*. 

Paul Lacroix, M. D. 


PUBLICATIONS RECEIVED. 

Oxford University Press, London: Breast- 

Feeding, by Margaret Emslie, M. B., Ch, B. 
Thomson & Miles’ Manual of Surgery, by Alex- 
ander Miles, M. D., LL. D., F. R. C. S., Ed., and 
D. P. D. Wikie, M. D., F. R. C. S., Ed. and Eng. 

P. Blakiston’s Son & Co, Inc., Philadelphia: 
Recent Advances in the Study of the Psychoneu- 
roses, by Millais Culpin, M. D. (Lond.), F. R. C. S. 
(Eng.). 

Paul B. Hoeber, Inc., New York: The Infant 

Welfare Movement in the Eighteenth Century, by 
Ernest Caulfield, M. S., M. D. The Physician of 
the Dance of Death, by Aldred iScott Warthin, 
Ph. D., M. D., LL. D. 

Williams & Wilkins Company, Baltimore: Fight- 
ing Disease with Drugs: A Symposium, edited by 
John C. Krantz, Jr. The Significance of Water- 
borne Typhoid Fever Outbreak, 1920-1930, by Abel 
Welman and Arthur E. Gorman. 

C. V. Mosby Company, St. Louis: An Intro- 

duction to Gynecology, by C. Jeff Miller, M. D. 
Clinical Dietetics, by Harry Gauss, M. S., M. D., 
F. A. C. P. 

The MacMillan Company, New York: Health 

on the Farm and in the Village, by C. E. A. 
Winslow, Dr. P. H. 

F. A. Davis Company, Philadelphia: Diabetes: 
Its Treatment by Insulin and Diet, by Orlando H. 
Petty, A. M., M. D., F. A. C. P. Textbook of His- 
tology, by Eugene C. Piette, M. D. Eye, Ear, 
Nose and Throat for Nurses, by Jay G. Roberts, 
Ph. G., M. D., F. A. C. S. 

Nervous and Mental Disease Publishing Com- 
pany, New York and Washington: Medical Psy- 

chology, The Mental Factor in Disease, by Wil- 
liam A. White. 

MacCrellish & Quigley Company, Trenton, New 
Jersey: Fifty-third Annual Report of the Depart- 

ment of Health of the State of New Jersey, 1930. ! 

Scientific Authors’ Publishing Company, New 
Yorfl: Text Book of Physical Therapy, by Wil- 

liam Benham iSnow, M. D. 


New Orleans Medical 

and 

Surgical Journal 

Vol. 84 AUGUST, 1931 No. 2 


NEWER DEVELOPMENTS IN CANCER 
RESEARCH.* 

CHARLES F. GESCHICKTER, M. D.f 
Baltimore, Md. 

The inherent mystery and the prize of 
fame and riches associated with the cancer 
problem has made this field of medical 
endeavor a most attractive one, both for 
scientific investigators, literary speculators 
and popular fancy. As the result, the vol- 
ume of scientific work, the mass of sugges- 
tions and trials submitted from all sources 
makes it exceedingly difficult to rise above 
confusion a.:d to present a clear summary 
of what is really being attempted of worth 
and to evaluate what has actually been 
achieved to date. 

Fortunately, despite the great diversity 
within the subject itself there are a few out- 
standing and definite problems under which 
all phases of cancer work may be considered. 
These outstanding problems relating to the 
field of cancer research are: 

1 — What is the nature of cancer ? 

2 — What is its cause? 

3 — How is cancer to be diagnosed? 

4 — How is cancer to be treated? 

5 — How is the profession and public to be 
educated in regard to this disease? 


*Annual Oration, read before the Louisiana 
State Medical Society, April 14, 1931, New Orleans. 

fFrom the Surgical Pathological Laboratory, 
Department of iSurgery — Johns Hopkins Hospital 
and University. 


While dwelling briefly on all of these 
questions, we propose to stress the current 
conceptions in regard to the nature of can- 
cer — since according to the concepts of its 
mode of origin, the control or cure of this 
disease must be planned. 

NATURE OF CANCER. 

No matter how reliable the compass nor 
how experienced the pilot, the captain of 
the ocean liner never rests assured of his 
course until a definite land mark is sighted 
and so in cancer investigation, no matter 
how scientific the work, and regardless of 
the progress made, there will never be 
unaminity of opinion and assurance of the 
nature or cause of cancer, until the entire 
prob'em is solved. Nevertheless, it is pos- 
sible to outline a definite direction in the 
work already accomplished in solving the 
nature of the disease and to make definite 
statements for which a consensus of opinion 
and adequate evidence will not be lacking. 

First, although specific infection, chronic 
irritation, injury and repair, biochemical 
forces, heredity and biological growth have 
been repeatedly presented by theorists as 
fundamental to the cause of cancer, the 
weight of scientific work today has centered 
more and more about the problems of bio- 
logical growth as essential to an under- 
standing of the disease. There still exist 
neverthe'ess laboratories of repute where 
the blood of cancer patients or the tumors 
themselves are being cultured bacteri- 
ologically for specific cancer organisms. 
There are also laboratories of the first order 
that are interested in producing tumors ex- 


96 


Geschickter — Newer Development in Cancer Research 


perimentally in chickens, by cell free fil- 
trates (so-called Rous chicken sarcoma) in 
the hope that a filterable virus or allied 
agent will be isolated that will prove funda- 
mental for cancer causation. But even if 
the very improbable and chimerical cancer 
germ could be found it would be only sec- 
ondary in importance to the causation of 
the disease, because our knowledge of can- 
cer has already passed the stage of draw- 
ing an analogy between it and simple in- 
fection. Moreover, the fact that cancer 
investigators may produce cancer at will 
experimentally, by painting the skin of mice 
with compounds of tar, directly opposes the 
viewpoint of these bacteriologically minded 
investigators. Certainly infection is not 
essential to the production of the disease, 
and infection alone will never account for 
true tumor formation. 

The microscopic structure of cancer which 
tends to duplicate the design and function 
of the tissue in which it arises detracts from 
the importance of external agents in the 
production of the disease and emphasizes 
the fact that cancer in the human body is 
more or less an intrinsic problem and that 
tumor growth in general is largely depend- 
ent upon the normal biological character- 
istics of the tissues from which the tumor 
arises. The weight of scientific opinion 
therefore, places the responsibility for can- 
cer fundamentally upon the individual and 
the portion of his body, where the tumor 
arises, rather than upon some outside agent. 
Not only is some constituent tissue of the 
body held responsible for the disease, but 
it is generally agreed that the disease begins 
locally and therefore it is some particular 
tissue at a particular age, and at a particu- 
lar site that makes possible the beginnings 
of cancer. This is another way of saying 
that the age incidence and localization which 
in long years of clinical experience have 
been found peculiar to each separate form 
of clinical neoplastic entity have a definite 
significance. 

The recognition of the local beginnings of 
cancer has been achieved with a high degree 


of accuracy for many types of tumors and 
is of considerable scientific and practical 
importance. It is forming the basis of an 1 
increasingly widespread campaign of edu- 
cation among the profession and the public 
in regard to these pre-cancerous, or early ; 
cancer spots which, when recognized and I ; 
treated early, lead to the prevention or cure 
of the disease. Not only is the profession 
and public learning to suspect the origin of 
cancer from such birth marks on the skin > 
as moles and angiomas ; chronic lesions in 
the mouth such as white patch or leuko- 
plakia ; ulcerating or weeping scabs (kera- j 
toses) on the face or hands, polyps in the h 
nose, colon, or rectum ; ulcerating lesions of j 
the cervix in women who have borne chil- 
dren ; warts, or irritation of the female | 
nipple ; congenital cartilaginous outgrowths | 
on the bones, etc., but in the light of recent 
research it is now understood why such ' 
birth marks and why such chronic sores 
constitute a likely focus. The scientific ! 
reasons may be formulated thus : 

Cancer in the human body begins always 
in one of the three ways: 

1. In an embryonic defect or local 1 
growth anomaly arising in fetal life or 
early childhood. (Moles, angiomas, exos- [ 
toses, etc., are thus explained as foci for | 
the disease.) 

2. In a normal growth zone active after 
birth in a phase of normal development. I 
(Giant cell tumor, chondrosarcoma of bone, : 
chorio-epithelioma, etc., take their origin in 
such growth zones.) 

3. In a normal growth zone activated 
through heahng and repair. (Keratoses, | 
warts, chronic ulcerations, etc., are ex- ; 
amples of this.) 

Such anatomical and physiological foci in : 
the body offer a foothold for the beginnings 
of cancer because here cells in a normally j 
undifferentiated state repose and retain an j 
inherent power for differentiation and fur- 
ther growth. In other words, there is a j 
common factor behind these foci. These 
are places in the human body where nature j 


Geschickter — Newer Development in Cancer Research 


97 


leaves her building stones behind — either 
unintentionally as an anomaly, or intention- 
ally for purposes of further growth or re- 
pair; and from these building stones the 
distorted and preverted structure of cancer 
is reared. 

These fresh and unused building stones, 
without which cancer cannot arise are not 
s left behind at random in the human make 
up, but are largely determined in location 
by the pattern of development of the par- 
, ticular organ, which in turn is predeter- 
i mined by evolution and embryology. Funda- 
mental studies into these normal patterns of 
development now underway and conducted 
: over a period of three years in the Surgical 
Pathological Laboratory of the Johns Hop- 
kins Hospital and University in conjunction 
with the Carnegie Institute for Embryology 
associated with the medical school have defi- 
nitely proved the relationship between the 
localized pre-disposed cancer spot harboring 
the persistence of juvenile cell groups (with 
power for differentiation and continued 
growth) and cancer. 

This fundamental basis for the cause of 
cancer has been demonstrated by evidence 
along four major lines. 

1. The growth zones of the organ or em- 
bryonic defects coincide by age and site 
with the localization of the tumor growth. 

2. Microscopic examination reveals the 
embryonic cell or unused building stone at 
both the normal site in the normal individ- 
ual before any tumor arises, and the iden- 
tical cell groups in an activated state at the 
same site after the tumor or cancer has 
arisen. 

3. Moreover, the manner and sequence 
in which the cancerous components of the 
tumor develop repeat in an identical order 
and pattern, the normal developmental 
structure of the part and tissue involved. 
This is the most recent and significant find- 
ing and is made clearer by the illustrations 
shown below. 

4. Finally, experimental etiddrice' deW 
onstrates that the normal growth zones or* 


juvenile cell groups can be stimulated by 
various means and made to mimick the act- 
ual cancer formation. 

These laws for cancer growth, and the 
demonstration of the role they play in the 
origin and development of tumor are best 
illustrated by considering their application 
to specific tumors. 

The duplication in pattern and sequence 
by the tumor formation of the normal em- 
bryology and evolution of the part involved 
by cancer is most convincing. That a living 
growth which runs so counter to the welfare 
of the organism in which it begins should 
follow in the footsteps of the embryologic 
and evolutionary development normal to 
that organism is unlikely, unless these very 
evolutionary forces themselves were con- 
cerned in the new growth. 

The connection between tumors of the 
giant cell group and the histogenesis of car- 
tilaginous ossification at the normal growth 
zone of the epiphyseal line in bones, was 
established by an analysis presented in the 
Archives of Surgery, August, 1929, Vol. 19, 
pp. 169-271 “Osteitis Fibrosa and Giant Cell 



Fig. 1A: Comparison of the histogenic cycle in giant cell 

tumor with the normal proliferation of giant cells occurring 
at *t|ie epiphyseal, tine. Figure 1A is a photomicrograph of the 
eJ)iphVs^ai; lin£ ;cvf a monkey foetus at, term. Calcified car- 
til^gj? Is: lj^ijig perforated by large multinucleated elements 
carrying in their wake newly formed capillaries. 


98 


Geschickter — Neiver Development in Cancer Research 



Fig. IB: Photomicrograph showing numerous giant cells 

occurring in a benign giant, cell tumor in an epiphysis. This 
prolferation of giant ce’ls in the neoplasm duplicates that 
in the foetus. 

Tumor” by Geschickter and Copeland. The 
fact that these lesions were proved to have 
their fundamental basis in a phase of the 
normal development of bone is the crux of 
this study. For, this analysis permits the 
conclusions that giant cell tumors can arise 
only at those sites in the body, and during 
those age periods when a proliferation of 
giant ce’ls represents a normal transition in 
osteogenesis (Fig. 1). In other words, these 
lesions which are true neoplasms are depen- 
dent in their origin upon a normal phase of 
tissue differentiation. Only when such a 
transition is normally occurring in the form 
of the resorption of calcified cartilage near 
an epiphyseal line does the possibility pre- 
sent itself for the development of such new 
growths. 

This conclusion in regard to giant cell 
tumor suggested that many neoplasms, 
whether benign or malignant, may invo’ve, 
and have their origin in, a normal phase of 
deve'opment at the time when a growth 'im T ' 


petus is manifested by an unstable phase of 
tissue differentiation, and other tumors of 
bone were studied from this viewpoint. 

Osteogenic sarcoma of the chondromyxo- 
sarcoma type and benign osteochondromas i 
occur at the transition point where tendons j 
attaching directly to bone maintain a center 
of cartilaginous ossification to co-operate in ! 
the formation of a normal bony protuber- 
ance acting as an anchor for the tendon. The 
chondromyxosarcoma or osteochondroma 
arising here duplicates in its histology the 
normal transitions in tissue defferentiation 
found in the tendon end as shown in the 
accompanying illustrations, (Fig. 2). These 
t* primarily malignant growths forming at 
such sites have a specific age incidence and 
occur in the post-adolescent growth period. 

Paget’s cancer of the female nipple occurs 
at a transition point where the basal cell 
layer of the skin in the nipple forms a tran- 
sition into the lining cells of the lactiferous 
ducts. The earliest stages in the new growth 
reproduce the histogenesis of the breast an- 
lage observed in the human embryo (Fig. 
3) . The disease is most prevalent after the 
menopause suggesting a reformation of the 
line of junction at this point after the 
change of life. 

Among the dental tumors the adamantine 
epithelioma occurs most frequently in the 
neighborhood of the molar teeth at an age 
period which corresponds roughly to the 
time of the second dentition (15 to 20 years) . 
This neoplasm arises from the enamel organ 
and, under the microscope, the transition 
from basal cells to columnar epithelium in- 
dicate an origin in, or close relationship 
with, the normal histogenesis of the tooth 
crown (Fig. 4) . 

The fact that a fundamental basis in nor- 
mal tissue differentiation has not yet been 
demonstrated in the majority of tumors 
dees not detract from the soundness of this 
interpretation but rather reflects the rarity 
and difficulty of making a thorough analy- 
sis of the histogenesis of specific varieties 
of neoplasms. 


Geschickter — Neiver Development in Cancer Research 


99 



a* 


'■ W> ’ 

' i.i 

' \ 1 1 ’ 


< |v;v* 

^ $ i 



\ * ‘ ! 


Fig. 2A: Comparison of the histogenic cycle in a benign osteochondroma with the growth center at the junction of the 

quadriceps tendon to the tibial tuberosity. Figure A is a photomicrograph showing cartilaginous ossification inter- 
vening between tendon and bone, in the quadriceps tendon. This is a normal growth center occurring in tendons that 
attach directly to bone and the transition from early connective tissue to cartilage to bone seen here is the basis for the 
osteochondroma shown in Figure 2B. 


Such a demonstration of the laws of de- 
velopment for tumor becomes increasingly 
more evident and important as additional 
types of tumors are analyzed. There is a 
definite need for this form of analysis — 
where the clinical features of age, site and 
behavior are coordinated with the tumor 
pathology and the normal pre-existing anat- 
omy of the part. 

For, it must be conceded =that* the foun- 
dations of tumor growth are laid in normal 


anatomy and embryology — by cell groups 
or building blocks set aside either accident- 
ally or purposely for replacement or further 
development of the tissues, and that the 
tumor growth involves the actual mechan- 
isms of the developmental forces them- 
selves. With this fundamental anatomical 
conception of the beginnings of cancer, it 
is important to learn if possible, what pre- 
cipitates these more naive, unsophisticated 
apd -persistent juvenile portions of the hu- 
njaii' bpcjit into tumor formation. 


100 


Geschickter — Newer Development in Cancer Research 



Fig. 2B: Photomicrograph of an osteochondroma or benign exostosis occurring at the point of tendinous insertion 

into bone. The connective tissue of the tendon overlies the cartilaginous portion of the growth giving rise to foetal car- 
tilage which is being transformed to adult and calcifying chondral tissue. Beneath is a proliferation of cancellous bone. 
Compare with Figure 2A. 


CAUSES OF CANCER. 

First it is known, that the cause or pre- 
cipitating factor is not one — and not to be 
elucidated by a single discovery — but that 
the factors to be demonstrated are as nu- 
merous and as variable as the influences to 
which these more primitive cell groups of 
the body may respond. 

1. It is known that, among other things, 
unusual growth tendencies, some of which 
may be inherited, as the cartilaginous tu- 
mors in hereditary exostoses, may stimulate 
such primitive cell groups into tumor 
formation. 


on the calcium and phosphorus metabolism 
in the bone, may give rise to multiple giant 
cell tumors in the skeleton. 

3. And again, infection or injury direct- 
ed at certain points, such as gonorrhea pro- 
ducing the spurs at the heel in the growth 
center of the tendon, or a blow starting an 
osteogenic sarcoma in the growing meta- 
physis of a young adult, may be instrumen- 
tal in the production of neoplasia. 

4. And the persistent demands for re- 
pair by chronic irritation and ulceration 
may be followed by cancer formation. 


2. Again, endocrine distubanc^s, . such, 4 , .But regardless of the number and variety 

as hyperparathyroidism, through- mfl5uen.c.e * ofi c.optrlbutd^y 'pauses that may be cited in 


Geschickter — Neiver Development in Cancer Research 


101 



Fig. 3A: 'Comparison of early Paget’s cancer of the 

nipple with early development of the breast at the nipple 
site. in the human embryo. Figure 3A shows the develop- 
ment of the breast in the embryo from the basal cell 
layer of the epidermis at the nipple site. The down-growing 
cords of cells are forming ducts which simulate the down- 
growth of cancer tissue shown in Figure 3B. 


the many clinical forms of cancer, two im- 
portant truths stand out as a result of care- 
ful pathological analysis and experimenta- 
tion: 

First, whether general or local influences 
are operative, the cancer producing effect 
only results when a specific locality capable 
of cell differentiation and further develop- 
ment is involved. 

Second. Experiments demonstrate the 
converse of this statement in that a single 
etiologic agent operating alone will never 
produce a true tumor. 

Thus the experimental injection of para- 
thyroid extract will produce an area of giant 





Fig. 3B: Photomicrograph of cancer cells proliferating from the basal cell layers of the skin and growing downward 

to produce ducts dilated with cancer tissue, in Paget’s disease of the nipple. 


102 


Geschickter — Newer Development in Cancer Research 



Fig. 4A: Comparison of the histogenic cycle of adaman- 

tine epithelioma with the embryology of the tooth crown. 
Figure 4A shows the formation of the tooth crown from 
the enamel organ in the embryo. Note how the transition 
of cell forms resembles that seen in Figure 4B. 

cells in the bone, but will not produce a true 
giant cell tumor. Trauma to a bone at a 
growth zone will stimulate a certain degree 
of overgrowth but true cancer formation 
does not occur. Apparently the only excep- 
tion is the production of cancer of the skin 
in mice after the application of coal tar. But 
here many repeated applications over a long 
period of time are necessary, which would 
seem to indicate that the irritation of the 
tar must await the development or occur- 
rence of some secondary conditon before 
giving rise to cancer. 

Although the entire picture is not com- 
plete, what has already been accomplished 
to date is sufficient to permit of important 
clinical applications, pointing the way for 
the control of the disease in its early or pre- 
cancerous stages and indicating the lines 
for further investigative work. 

The fundamental viewpoint embodied in 
the conception of cancer as a local tissue 
change concerned with cell growth here 
elaborated, is old and wide-spread. The rea- 
sons why an analysis of the evidence in 


favor of this conception and its application 
has not been conducted more energetically 
and along more thorough and broader lines 
is quite obvious. The bulk of cancer re- 
search either takes the form of isolated and 
abstract animal experimentation or is a gold 
rush, a short cut to a cure. 

Too often the horizon of the experimenter 
is confined to his own particular laboratory 
without clinical contacts or constant touch 
with the clinical information in regard to 
cancer as it appears in human beings and 
rarely rises above the intricate manipula- 
tions of his chosen experimental method. Or 
he is a convert to the realms of research who 
has been newly imbued with the hope of 
discovering a cancer cure. 

A co-ordination and bringing together of 
the disconnected efforts along the various 
lines of embryology, patholgy, endocrinol- 
ogy, and clinical investigation as well as 
the more abstract studies of biophysics and 
biochemistry are not only necessary to the 
cancer problem; but workers in these sepa- 
rate fields need the stimulation as well as 
the aid of such a variety of combined stu- 
dies. Until we are ready to divert a definite 
portion of clinical effort in cancer to the 



Fig. 4B: Photomicrograph showing ' the transition of 

basal cells to enamel epithelium of the columnar type, 
typical of adamantine epithelioma. 


Geschickter — Newer Development in Cancer Research 


103 


ends of research and until we learn to ex- 
pect more of guided and coordinated effort 
in scientific research, the solution of the 
cancer problem is doomed to lie fallow in 
the middle ground between the diletant of 
pure science on the one hand, and the ama- 
teur cure-seeker on the other. We are ex- 
pecting today too much of individual and 
chance discovery and not enough of con- 
certed, well directed and organized effort. 

DIAGNOSIS OF CANCER. 

Methods in the diagnosis of cancer may 
be divided into systemic and local in scope. 
The systemic methods aim at discovering 
some change in the blood or body fluids or 
the excretions of cancer patients which will 
indicate the presence of cancer when the 
tumor is not discernible or when the char- 
acter of the growth is in doubt. Local 
methods are aimed at an examination of 
tissue removed from the actual tumor itself 
and endeavor to demonstrate by measure- 
ments or reactions the presence of cancer 
or its absence in the tissue examined. 

Systemic Methods of Diagnosis : The 

newer investigations in cancer diagnosis are 
largely in the systemic field. Many attempts 
have been made to devise a type of test 
which would show the presence of cancer 
in a patient when a small sample of blood 
is obtained for diagnosis. These tests have 
largely been modelled after the Wassermann 
of Kahn test for syphilis, but to date none 
have definitely proved of clinical value. 
More hopeful results have been obtained by 
tests which rely upon an examination of the 
urine of cancer patients. Ferguson! at the 
Memorial Hospital in New York has re- 
cently shown the presence of a pituitary 
substance in patients suffering with malig- 
nant tumors of the testicle which is excret- 
ed in the urine in detectable amounts. At 
present, however, the test only applies to 
certain types of tumors found in the genital 

^Preliminary note on a New Method of Differ- 
entiating the Testicular Tumors by Biological 
Means by Russell S. Ferguson, Helen R. Downs, 
Edward Ellis and Mary E. Nicholson; American 
Jour, of Cancer, 15:835, 1931. 


tract. One laboratory is studying the ex- 
cretion of sulphur which is supposedly 
higher in cancer patients. This latter test 
is not yet on a clinical basis. 

Local Methods of Diagnosis: There are 

two chief methods of diagnosis applicable 
locally to cancer tissue. One of these is 
microscopic, the other metabolic. Microsco- 
pic methods re’y either upon the finding of 
unique structural characters in the cancer 
tissue such as peculiarities in the cell nu- 
cleus, or upon unique staining reactions of 
the tissue when certain dyes are applied. 
The microscopic method surpasses all other 
modes of cancer diagnosis in accuracy and 
is the standard for comparison. Unfortu- 
nately it is not absolutely accurate and it 
has a large personal equation dependent 
upon the proficiency of the examiner. For 
this reason there is a definite demand for a 
differential stain which will make the pres- 
ence of cancer certain by its color reaction. 

New metabolic methods of diagnosis have 
been attempted on cancer tissues which en- 
deavor to measure either the formation of 
lactic acid or the reducing power of the 
tumor. (The rate at which it will withdraw 
oxygen from a substance or the equivalent) . 
Both lactic acid formation and the reducing 
power of cancer is higher than in most nor- 
mal or diseased tissues, but not absolutely 
so in all cases. In addition the biochemical 
methods of measurement have a factor of 
error, because normal defensive cells are al- 
ways crowded in around the tumor cells. For 
this reason the newer experiments attempt- 
ing to measure the biochemical properties 
of cancer are endeavoring to use tissue cul- 
tures of pure tumor cells rather than cancer 
tissue. 

Tissue culture of animal tumors is not 
new, the successful and continuous growing 
of human cancer cells is however, more re- 
cent. Among other things these newer stu- 
dies have shown that there are different 
growth properties in cancer and sarcoma, 
that a peculiar variety of tri-partite mitotic 
division takes place in malignancy that re- 


104 


Geschickter — Newfr Development in Cancer Research 


suits in bi-nucleated tumor giant cells, and 
emphasize again the ad-mixture of nojmal 
reactive cells and phagocytes always present 
in actively growing tumors. 

The study of properties peculiar to the 
malignant cell, and of the metabolic and 
serological findings in cancer patients prom- 
ises to be one of the most fruitful fields of 
cancer investigation in the near future. The 
probabilities of the discovery of various 
tests which will increase the accuracy and 
ease of cancer diagnosis seem particularly 
likely in the not remote future. In addition 
it is not at all unlikely that the finding of 
specific properties in tumor tissue will pro- 
vide fairly readily therapeutic applications. 

TREATMENT OF CANCER. 

The American Society for the Control of 
Cancer within the past few months, in a 
communication given to the daily press, stat- 
ed that there exist today only three proved 
and effective methods of treating cancer: 
surgery, radium and roentgen-rays, and that 
to be effective these must be applied prompt- 
ly and competently after an early diagnosis. 
These three standard methods of treatment, 
surgery, radium and roentgen-rays, have 
had no adjuncts added in recent years, with 
the exception of improvements of the deep 
roentgen-ray machine. 

The science of electricity has recently dis- 
covered how to obtain and control voltages, 
exceeding 1,000,000, and this so-called arti- 
ficial lighting is finding application to the 
field of deep roentgen-ray therapy in cancer 
cases. Three of such high voltage roentgen- 
ray tubes are in existence, one in Los An- 
geles, one in New York and the other in 
Washington, D. C. It is too early to pre- 
dict the clinical results that will be obtained 
by these more powerful roentgen-ray de- 
vices, but apparently the present generation 


is about to witness the perfection and 
ultirhate limitations of irradiation as 
applied to cancer, in the same manner 
that the last generation witnessed limi- 
tations of radical surgery as applied to 
cancer. In all probability, irradiation, like 
surgery, will leave the ideal treatment for 
all types of cancer early and late, still un- 
attained. It is important to emphasize once 
again in discussing these accepted types of 
cancer treatment — as well as alluding to the 
more exaggerated and unfounded claims of 
extracts, serums, metals, and colloids as 
cures for cancer that the efficacy of any pro- 
posed cancer treatment must be judged by: 

1. Its use in cases of cancer which have 
been microscopically proved. 

2. Its use in cases which have passed 
the local stage of tumor growth and have 
recurred or spread to other parts of the 
body, and 

3. Its capacity to produce permanent 
cures in patients with the above type of 
tumors who have remained well five years 
after the beginning of treatment. 

THE EDUCATION OF THE PROFESSION AND 
THE PUBLIC IN REGARD TO CANCER. 

It is now established that cancer can be | 
cured if properly treated in its earlier stages 
while still localized, and largely prevented, j 
if adequately dealt with in its precancer- ! 
ous state. Therefore, teaching the public to j 
come early by stressing periodic health ex- ! 
aminations and emphasizing the first warn- j 
ings of malignant disease and teaching the i 
profession higher standards of promptness ; 
and accuracy in cancer diagnosis is the ac- j 
cepted order for today, and tomorrow’s 
medical ethics. Already New York, Massa- 
chusetts, Canada, New Orleans and many 
other states and cities have taken part. The 
movement will soon be national in scope. 


Fenner — Acute, and Chronic Osteo-Myelitis 


105 


ACUTE, AND CHRONIC OSTEO- 
MYELITIS.* 

E. D. FENNER, M. D., 

New Orleans. 

Is any apology necessary for presenting 
once more the well-worn subject of acute 
osteomyelitis, and its sequel, chronic osteo- 
myelitis? The literature is teeming with 
admirable descriptions of the disease. The 
story of its terrible mortality, its symptoms, 
and its treatment are within reach of your 
fingers in any medical library. But, some- 
how or other, the lesson has not sunk in. 
The high mortality continues; in patients 
who survive the stormy invasion, the trans- 
formation of acute osteomyelitis into 
chronic osteomyelitis drags its slow length 
along through years, punctuated by re- 
peated operations, and often terminates in 
crippledom; in spite of admonition, warn- 
ings, insistence, men — and piretty good men 
at that — continue to turn blind eyes to a 
clinical picture by no means difficult to 
recognize, and this at the onset of the 
disease when recognition, and clear eyed, 
bold action are so vital to the safety of 
the patient. 

Acute osteomyelitis is a juxta-epiphyseal 
infection of the diaphysis of the long bones 
by the staphylococcus aureus. Occasionally 
we see an acute osteomytelitis due to strep- 
tococcal, or other infection, but these cases 
are rare. The bacteria are carried in the 
blood stream, and deposited in the diaphysis 
near its extremity. Their source is distant, 
a sore throat; an infected tooth; a skin 
infection, such as an impetigo, a furuncle, 
an infected abrasion. The blood infection 
is usually transient, and within a brief 
time blood cultures will be negative. If a 
bacteriaemia persists, you have a very bad 
case, and the patient is not apt to recover. 
Spreading of the infection within the bone 
to the epiphysis is not common, owing to 
the firm attachment of the periosteum at the 
epiphyseal line, and to the protective barrier 

*Read before the Orleans Parish Medical 
Society, March 9, 1931. 


of this layer of cartilage. Rapid extension 
of the infection of the diaphysis, on the 
other hand, is inevitable, and is in direct 
proportion to the delay in affording an exit 
to the pus locked up within the bony shell. 

The deposit of the staphylococci in the 
bone is favored by trauma. A large per- 
centage of cases give a history of slight 
injury shortly before the onset of the 
disease. Age is a real factor, since the 
great majority of cases are seen in the 
young. Probably 80 per cent are less then 
16 years, and more than 50 per cent are 
below 10 years of age. Perhaps because 
of their rougher play, and consequent 
greater liability to injury, boys are more 
frequent victims than girls. Lowered 
vitality, previous illness, diabetes, are other 
causative factors sometimes mentioned, but 
it is certain that many cases have been 
normally robust. 

The symptomatology is characteristic, 
and remarkably definite. Following an 
injury, not considered as having any 
significance at the time, a young child is 
seized with a violent pain in the neighbor- 
hood of one of his joints — the knee, the 
elbow, the hip, or the ankle. Fever develops 
rapidly, perhaps attended by a chill. The 
pain is very severe, and is at first pretty 
definitely restricted to a small area near the 
joint. Tenderness to pressure is likewise 
localized to a sma’l region, near, but not in 
the articulation. Toxemia develops rapidly, 
and the patient is plainly very sick. 
Soon there develops swelling, but this 
too is near, but not in the joint. 
Attempts to move the limb give excruciat- 
ing pain, but by extreme gentleness you can 
usually convince yourself that the articula- 
tion itself is not the seat of the pain. It 
is close by, but not actually in the joint. 
The leukocyte count rises rapidly to 20,000 
or more. Hot applications increase instead 
of moderating the pain. The toxemia 
steadily grows more threatening and the 
patient may be delirious. For at least a 
week the roentgen-ray picture is negative. 
Meanwhile, the whole limb may have be- 


106 


Fenner — Acute, and Chronic Osteo-Myelitis 


come swollen, and if the child does not 
succumb to the toxemia, he is, at least, in 
a par ous state. After a varying number 
of days pus breaks through the periosteum, 
accumulates in the soft tissues, and an 
abscess is unmistakable. During this crucial 
period the doctor has been marking time, 
but now at last he finds something to do. 
He timidly makes a small incision through 
the skin, and evacuates the pus. But the 
fever and toxemia are relieved for only a 
brief period, and the patient is again on the 
toboggan. A second roentgenogram is now 
taken, and bone changes are only too 
evident. At last, we have a case of osteo- 
myelitis, and some sort of effort is made to 
relieve the pressure of pus within the bone. 
The patient perhaps survives, but extensive 
necrosis of the shaft proceeds, and he 
passe:, into the class of chronic osteomye- 
litics, undergoing one operation after 
another, and spending years of chronic 
invalidism. 

Now why should this be the usual his- 
tory of these cases? The clinical history is 
clearer even than that of an acute append- 
icitis. It has been described again and again 
with vivid emphasis. The combination of 
sudden, agonizing pain in the neighborhood 
of a joint, but not in the joint itself, in a 
young subject, following a trivial injury, 
with evidence of a distant focus of infec- 
tion; the abrupt r’se of temperature, with 
severe toxemia; the early onset of swelling 
near the joint, but not in the articulation 
itself ; the localization of exquisite tender- 
ness near the joint; the high leukocyte 
count; this almost unvarying group of 
signs and symptoms should point straight 
to the signboard marked acute osteomye- 
litis. But, do they? You all know how 
persistently the doctor will turn to rheu- 
matism as an explanation. Sub - acute 
rheumatism of a single articulation is not 
uncommon in the young, but it is no violent 
and stormy affair like this. It causes no 
high fever, no desperate constitutional de- 
pression, no high leukocyte count ; whatever 
swelling and pain are present are in the 


joint, not near it. Acute rheumatic fever 
is seldom monarticular, but involves a 
number of articulations. The swelling is 
in the joints themselves, the pain is there, 
too. Fever may be high, but toxemia is 
net suddenly severe. Acute infectious ar- 
thritis, for instance, the gonococcal, pre- 
sents a similar picture of unmistakable 
joint trouble. We may dismiss such diag- 
noses as typhoid fever, blood poisoning, and 
the like, since they have no meaning in 
connection with such a history as is given 
by these patients. They are mere camou- 
flage to stall off a gullable family. 

The outstanding and disheartening fea- 
ture in the history of acute osteomyelitis 
is delayed diagnosis, and delayed treatment 
of the right sort. The average doctor is 
not likely to encounter many such cases in 
his practice, and the picture of this viru- 
lent bone infection is apt to be obscured by 
his more ordinary experiences. Muscular 
spasm which fixes a joint in flexion, and 
is accompanied by severe pain and fever, 
suggests joint trouble to him. Within the 
joint and near the joint are not far apart. 
Experience has taught him that frequently 
joint troubles will get better if they are 
given salicylates and rest. Meanwhile, his 
attention is so fixed upon the joint that he 
pays too little attention to the general con- 
dition of his patient. A negative roent- 
genogram confirms his hesitation. The 
vio'ent constitutional disturbance, - the in- 
tense local signs and symptoms, vivid red 
signals of danger, are disregarded until 
the accumulation of pus beneath the skin 
suggests another roentgenogram, and bone 
destruction is apparent. 

Now what is the lesson to be learned in 
regard to this formidable bone infection? 
In the face of the clinical picture already 
described — sudden, violent pain and tender- 
ness near a joint, with high fever, severe 
toxemia, localized swelling, and leukocy- 
tosis, in spite of a negative roentgen-ray 
report, lose no time on fomentations or 
watchful waiting. Cut down upon the bone 
over the tender spot, incise the periosteum. 


Fenner — Acute, and Chronic Osteo-Myelitis 


107 


and drill a hole in the bone. Depending 
entirely upon how many days it has taken 
you to screw your courage to the drilling 
point, pus may be encountered beneath the 
skin, beneath the periosteum, or only after 
you have drilled the bone. After you have 
taken up your knife and incised the skin 
do not rest satisfied until you have made 
an opening in the bone as well. When pus 
wells up from the drill hole, enlarge the 
opening until you are certain that drainage 
is adequate. See that the incision through 
the soft parts is large enough to expose the 
bone readily. Dry the wound, and flood it 
with tincture of iodine, followed by alcohol, 
and loose y pack the wound wide open with 
strips of sterilized vaseline gauze. Intro- 
duce no sutures, but pack the wound wide 
open. Apply a heavy gauze dressing, and 
encase the limb in a plaster of Paris splint 
to secure absolute immobilization. From 
now on, do not worry about the wound, but 
watch the patient. If the toxemia abates, 
and the fever subsides, as they are apt to 
do, the wound need not be disturbed for 
days or even weeks. The only indications 
for interference with the plaster of Paris 
case, and the gauze pack, are persistence 
of fever and toxemia, and a stink arising 
from the limb too great to be endured. If 
fever and toxemia persist, it is fair to 
assume that drainage is still inadequate, 
and that a wider opening of the bone is 
needed, and this should not be delayed too 
long. In the absence of such symptoms, the 
longer the wound can be let alone the better. 
When you conclude that a second dressing 
is advisable, although the patient is com- 
fortable, free of fever, and of toxemia, you 
will find the affected region soaked with 
stinking pus, but filled with healthy granu- 
lations. Cleanse the skin with alcohol, 
flood the wound cavity with tincture iodine, 
followed by alcohol, and repack with the 
vaseline gauze. Put on a new immobilizing 
plaster of Paris case. Let this alone as long 
as you can stand the smell. 

This is the Winnett Orr method of treat- 
ing osteomyelitis. In acute cases the bone 


is opened widely enough to ensure free 
drainage. If this has been done early, the 
process may be arrested ; where there has 
been considerable delay relief of tension 
may have come too late to prevent exten- 
sive necrosis of the shaft. The latter fall 
into the chronic stage, and a secondary 
sequestrotomy will be needed. At this time 
expose the bone freely, remove the whole 
roof of the diseased area, together with any 
sequestra, saucerize the bone cavity, and 
pack as before. 

Many years of disappointment with older 
methods, and the results obtained within 
the last few years with Winnett Orr’s 
method, have completely converted me to 
his following. The saving in dressing 
material, in the surgeon’s time, and in 
suffering to the patient, which results from 
these infrequent dressings, are not to be 
lightly dismissed. What matters a bad 
smell in view of the extraordinary progress 
of the case towards cure? Winnett Orr 
himself has suggested that some sort of 
defensive mechanism was set up by his 
combination of wide open drainage, sub- 
sequent non-interference, and perfect im- 
mobilization. Aibee has expressed the 
opinion that the conditions created resulted 
in the development of a bacteriophage. 

Wilhelms has taught us that suppurating 
joints, opened widely to ensure drainage, 
with drainage tubes or gauze packs abso- 
lutely forbidden, and frequently mobilized to 
pump out the pus, could be restored to 
perfect function and freedom of motion. 
Winnett Orr, recognizing the differences of 
structure in the parts concerned, has shown 
u.s that infected bone could be induced to 
heal by adequate drainage, infrequent 
dressings, and perfect immobilization. To 
both these men the profession owes a debt 
of gratitude. 

DISCUSSION. 

Dr. Urban Maes (New Orleans) : Dr. Fenner 

has left me little to discuss for the reason that he 
has already considered in detail the most important 
fact about osteomyelitis, the necessity of its early 
diagnosis. If that fact were borne steadfastly in 


108 


Fenner — Acute, and Chronic Osteo-Myelitis 


mind, there would be no necessity for discussing 
the treatment of Winnett Orr or the treatment of 
Baer, but since it is very generally ignored, the 
management of late cases always forms a large 
part of every symposium on the subject. 

A few years ago I looked over the records of 
Touro Infirmary, and I found, in analyzing the 
cases of osteomyelitis, that the diagnosis had been 
missed in practically every instance until bone 
destruction and constitutional symptoms were 
evident, Fifty per cent of the cases were diagnosed 
as toxemia, and the other diagnoses included ar- 
ticular rheumatism, typhoid fever and tuberculosis. 
In almost every case the diagnosis was missed 
because the first roentgen-ray studies were nega- 
tive, and Dr. Fenner has very properly emphasized 
the fact that mistakes are going to occur just as 
long as the roentgen-ray is relied on for diagnosis, 
because, in the early stages of the disease, bone 
destruction has not occurred and the roentgen-ray 
is always negative. 

Some years ago I made the point before this 
Society, in a similar discussion, that it would really 
be a conservative policy to explore every case in 
which we suspect osteomyelitis, for the reason that 
an exploration does no harm while delay in treat- 
ment always results in prolonged disability, if 
nothing worse. An elaborate armamentarium is 
not essential; a scalpel and a ten cent carpenter’s 
gimlet is all that is necessary. Nor is the pro- 
cedure difficult; it amount to nothing more than 
the boring of a few holes in the proper place in 
the diaphysis, with the proper precautions, of 
course, to protect the epiphysis. 

At the same time I called attention to the facts 
which Dr. Rives has alluded to in a previous dis- 
cussion. At that special time we had four patients 
in our ward whose aggregate disability, from 
failure to diagnose the disease promptly, was over 
•one hundred years. I note in a recent issue of 
Surgery, Gynecology and Obstertics that Brunsch- 
wig reports three patients with an aggregate 
disability of over fifty years. Two of these cases 
required amputation, and in three other cases he 
reports, in which he attempted conservative treat- 
ment the patients disappeared from his observation 
still with suppurative infections. 

Certain points about osteomyelitis must con- 
stantly be borne in mind: 

1. That the disease is a clear cut entity, with 
definite symptoms which follow in regular sequence 
and which are recognizable within a few hours 
after the onset. 

2. That failure to recognize the disease in the 
■early stages invariably results in pathology of the 


chronic type, with long periods of disability in some 
cases, and with a fatal outcome in others. 

3. That the local manifestations of the disease 
are extremely important in diagnosis, for the 
reason that the constitutional symptoms mimic the 
symptoms of other diseases. 

4. That dependence on the roentgen-ray for the 
diagnosis of acute osteomyelitis is a grave error, 
for the reason that the roentgen-ray findings are 
always negative in the period when treatment is 
of most avail. 

I have had practically no experience with the 
methods of treatment advocated by Winnett Orr 
and by Baer, but it strikes me as most unfor- 
tunate, in the face of all that is known about 
osteomyelitis, that it should ever be allowed to 
progress to the stage in which such repugnant 
methods are necessary. Orr lets his cases progress 
to the point of putrefaction, and perhaps, if you 
can endure to live around the patients, that is a 
satisfactory mode of treatment. Baer goes even 
further, in that he has maggots, and trained 
maggots, at that, put into the wound to eat out 
the necrotic tissue, a procedure, again, that may 
be curative but is certainly unsurgical. Neither 
method, however, as I have already said, would 
ever have to be invoked if the points that 
Dr. Fenner has made were borne constantly in 
mind. 

Dr. E. S. Hatch (New Orleans) : I would like 

to emphasize what Dr. Fenner has said about the 
importance of early diagnosis and say just a few 
words about Dr. Orr’s treatment. 

In the older methods of treating osteomyelitis 
the doctor and the patient both had a hard siege, 
the doctor hating to hurt his patient and the 
patient dreading the visit of the doctor. 

By using Orr’s method, the bone cavity- is cleaned 
out, packed with sterile vaseline gauze strips; 
dressing applied and a plaster cast put on. 

It is my habit to let these casts alone for from 
four weeks to six weeks, as patients do not have 
any pain, discomfort or temperature, but they do 
have a very bad odor from the accumulating 
drainage. When the cast and dressings are re- 
moved after several weeks the wound presents a 
healthy granulating surface. 

Dr. E. Denegre Martin (New Orleans) : I have 

not very much to add, except to emphasize what 
Dr. Fenner has said about early diagnosis. Some 
years ago when I had the Colored Clinic, I had 
many to come in as chronic cases. 

In my own practice I have seen three cases 
first diagnosed as typhoid fever and treated as such 


Fenner — Acute, and Chronic Osteo-Myelitis 


109 


for six weeks. Results in these cases: resection of 
left hip joint, resection of right ankle joint, and 
involvement of every bone in the body. I was 
just thinking that had we used Orr’s treatment 
on these cases we would have been unable to get 
in the house at all on account of the odor. 

In operating on these cases we must get rid of 
the infection at the time of operation. There 
would be little danger if you curetted these cases 
thoroughly, but they will have high temperature 
if you pack them. Carbolic acid solution strong 
enough to destroy bacteria will destroy tissue. I 
believe, if you get rid of the infection in the be- 
ginning, any treatment will do. 

One thing to be avoided in all treatments is 
redressing cases two often. Every time you dress 
these cases you are very apt to delay healing and 
I have made it a rule never to cleanse a wound 
unless necessary. 

We must differentiate from other diseases. 
There is always pain around the joint. I have 
seen cases where pain was only in the shaft. A 
few years ago I was called in to see a case of 
pneumonia. I discovered that the child had osteo- 
myelitis. The problem was to wait until the child 
was well of the pneumonia when it might be too 
late. So I drilled two holes about 14 inch and 
allowed the pus to escape and warded off the 
danger until the child was cured of the pneumonia 
when I finally drained and curetted the cavity. 

Dr. A. C. King (New Orleans) : I do not think 

this subject ought to go without further discussion. 

Dr. Fenner, in describing a while ago why 
these cases became chronic asked the pertinent 
question of “why” this occurs. There seems to 
me to be two reasons: One is the patient and 

the other is the doctor. Oftentimes, the patient 
will diagnose his condition as rheumatism and the 
disease will go on for several days, progressively 
getting worse before the physician is called in. 
When the doctor does arrive, he concurs in the 
diagnosis of rheumatism or typhoid fever, and the 
disease gets worse until much damage has been 
done. 

Dr. Maes has made the statement that it is a 
plain open thing and easy to diagnose. To the 
man who has had considerable experience I will 
agree that it is. Appendicitis was an open and 
easy thing for John B. Murphy, but not to the 
general practitioner, with ’the result that many 
cases went on to death unrecognized. In osteomye- 
litis, the profession as a whole is up against the 
same problem. If we were called to see as many 
cases of osteomyelitis as appendicitis then we 


could easily make an early diagnosis, which means 
early operation with early recovery. These three 
things go together : early recognition, early opera- 
tion, early recovery. Late recognition means tre- 
mendous disability and in many cases loss of life. 

Dr. Elizabeth Bass (New Orleans) : There is 

one very important step in the differential diag- 
nosis of acute osteomyelitis from other infections 
of the bone that has not been mentioned, namely, 
the examination of the urine. It has been my 
observation in a number of cases of osteomyelitis 
that the urine shows albumen and a variety of 
casts especially coarse granular and frequently 
amyloid, whereas, in tuberculosis, rheumatism and 
other joint and bone disturbances the urine is 
usually normal. 

Dr. Frank L. Loria (New Orleans) : Having 

been a student under Dr. Fenner I feel greatly 
indebted to him for much of my knowledge of 
osteomyelitis. Two phases of this subject, how- 
ever, which have not yet been covered struck me 
as being important enough to mention. 

The first is that phase in the disease frequent- 
ly spoken of as metastatic osteomyelitis — or a 
second distantly involved bone. Whether or not 
the original nidus of infection has anything to 
do with these cases, I think, is still detalable. 
Nevertheless, in two such cases, observed by 
myself, the symptoms resulting from the second 
focus were considerably more mild than those 
resulting from the original focus, and the diag- 
nosis was much delayed in each case. One of these 
cases had an original focus in the left tibia five 
years previously and recently I operated upon 
him draining pus from his right humerus. The 
symptoms resulting from infection in the humerus 
were so mild that two other men agreed the con- 
dition, even with roentgen-ray plates, was probably 
syphilitic. The other case was in a child about 
12 years of age with a pretty severe acute original 
focus in the left clavicle and a later low grade 
infection of his right tibia, so mild that the diag- 
nosis of bone tumor was ventured by one man. 
However, operation proved the presence of a low 
grade (Brody’s) abscess. 

The second phase of great importance to me, 
and which should probably rank as phase number 
one, concerns early diagnosis and osteotomy in all 
cases that can not definitely be proven not to be 
osteomyelitis. We know that properly performed 
osteotomy — whether the case at hand be or not be 
osteomyelitis — is free from deleterious results. For 
this reason, I do not hesitate to perform an osteot- 
omy on every case in which I am not sure the 
condition is not osteomyelitis. Two very recent 


110 


Fenner — Acute, and Chronic Osteo-Myelitis 


experiences have impressed this idea even more 
forcefully on my mind. 

Recently I was called in to treat a young man 
about 20 years of age complaining of severe pain 
below his right elbow and over the head of the 
right radius. There was a history of fracture in 
this region about 12 months previously. The 
temperature was around 103° and the onset very 
abrupt. The blood count showed more than 20,- 
000 whites (made by Dr. F. M. Johns) and I was 
convinced I was dealing with a case of acute 
osteomyelitis. Accordingly, I performed an os- 
teotomy, but the next day his fever had not sub- 
sided. On the following day a left middle ear 
abscess ruptured and the fever subsided. No soft 
tissue abscess formed at the site of the osteotomy 
and healing was by first intention. 

Another case was that of a boy five years of 
age who developed pain in the right leg. His 
mother said he had no chills nor convulsions and 
that his fever was never above 102°. The blood 
count was 11,000 and although pressure elicited 
some pain over the lower regions of the right 
tibia this was not very marked. However, I de- 
cided to perform an osteotomy and to my sur- 
prise the culture from the bone marrow showed 
staphylococcus aureus and a soft tissue abscess 
formed as usually happens in these cases. 

To reiterate I would suggests first that the mat- 
ter of later distant foci of infection be kept in 
mind as also the relative little damage that might 
occur following a properly performed osteotomy: 

Dr. E. D. Fenner (closing) : How many thou- 

sands of articles were needed to bring the pro- 
fession and the public to the point where they now 
are in regard to acute appendicitis? And how 
many thousands of articles are going to be need- 
ed accomplish the same thing in regard to acute 
osteomyelitis? The records of any hospital — 
here, in New York, in Philadelphia — will show 
that operation for acute osteomyelitis is usually 
delayed for days, often for weeks. It is going 
to take a great many articles to arouse the pro- 
fession and the public to recognize what is, in 
fact, as clear a clinical picture as is shown by 
any disease we see. 

Now when it comes to the question of what you 
should do, my own opinion is that any surgeon 


who has gotten up the courage to operate upon 
a case which presents this typical picture, had 
better not stop at the periosteum, but should go 
into the bone. Pus that can run out freely does 
not do much harm; when it is confined, you get 
toxemia. 

I remember passing through the operating 
room one day while my friend, Dr. Landry, was 
operating upon a case of chronic osteomyelitis, 
to which he called my attention. He had saucer- 
ized the bone area, put in an iodoform gauze 
pack, and introduced five or six good big sutures. 
I said to him, “Landry, if you will take out all 
your sutures, replace your iodoform gauze with 
sterile vaseline gauze strips, and pack the wound 
wide open, you will get a real surprise, particu- 
larly if you will put on a plaster of Paris case, 
and then let it absolutely alone for several weeks.” 
He came to me in about six weeks, and said, “Fen- 
ner, I would never have believed I could get such 
a result as I have.” 

Saucerize the bone through an incision in the 
soft parts which extends beyond the affected bone 
area; cleanse the cavity with tincture iodine, fol- 
lowed by alcohol; loosely pack the cavity with 
sterile vaseline gauze; put on a plaster case, and 
make no change of dressing for several weeks, 
provided there is no fever; and when you do re- 
move the plaster case, you will find a stinking, 
pus soaked dressing, but the cavity will be filled 
up with good, healthy granulations. Renew your 
vaseline pack, your gauze dressing, and your plas- 
ter case, and forget about them for another 
month. You are going to have cases of osteo- 
myelitis cured in three or four months, instead 
of lingering on for fifty years as Dr. Maes has 
remarked. 

One of the things that induced me to write 
this paper is the fact that our hospital records 
show that only once in a blue moon is a case of 
acute osteomyelitis operated on within forty- 
eight hours; most of them wait for days. The 
pus, confined under tension within the bone, pro- 
duces extensive necrosis. You would not have 
it if the pus could have found an exit. 

I sincerely hope that someone will come back 
here next year, and the year after that, and re- 
peat the lesson I have tried to bring home to you. 


Granger — Treatment of Infections of the Mastoids of Infants 


111 


THE TREATMENT OF INFECTIONS OF 
THE MASTOIDS OF INFANTS, WHEN 

THERE IS NO SIGN OF DESTRUC- 
TION PRESENT, WITH FRAC- 
TIONAL DOSES OF THE 
ROENTGEN RAYS.* 

AMEDEE GRANGER, M. D.,f 
New Orleaks. 

The favorable influence which fractional 
doses of the roentgen rays, even the sma’l 
amount of these rays administered while 
making a radiograph, have on mastoiditis 
complicating middle ear disease, was 
observed more than two years ago while 
I was engaged in an intensive radiographic 
study of the healthy and diseased mastoids 
of infants. 

Last December in Toronto when I pre- 
sented the result of that study to the 
Radiographical Society of North America 
I made the following statement: “In a 

number of cases too large to be attributed 
to mere hazard or coincidence, patients 
with definite signs of infection and occlusion 
but not of softening and destruction of the 
mastoids were decidedly improved by the 
irradiation incidental to the making of the 
radiographs and went on to reso'ution and 
cure. This observation was confirmed by sev- 
eral competent oto-laryngologists and was 
especially noticeable in some patients who, 
prior to the radiographic examination, had 
run a slow low grade course over a period 
of several days without improvement. As 
a logical result of this observation, when the 
clinical manifestations are slight and the 
radiographs show no sign of destruction 
my colleagues of the oto-’aryngological 
specialty in both hospital and private prac- 
tice institute a period of from two to five 
days of watchful waiting and then if the 
condition shows no sign of clearing up or 
if the clinical examination indicates that it 


*Read before the Orleans Parish Medical Society, 
November 24, 1930. 

fDirector of the Department of Radiology, 
Charity Hospital, Professor of Radiology, Tulane 
Post Graduate Medical School. 


has become worse, other radiographs are 
made and these invariably show signs of 
softening or destruction.’' 

At this juncture I will describe the posi- 
tive sign of destruction of the mastoid 
which I discovered while making that study, 
and I hope that it will prove as valuable to 
you as it has to me in the diagnosis of these 
troublesome cases. 

The shadow of the sinus-plate (groove for 
the lateral sinus, anterior wall of the lateral 
sinus) normally seen in the radiographs of 
mastoids of adults and children over three 
years of age, made in the Law position, is 
sinus) normally seen in the radiographs of 
healthy mastoids of children under three 
years because the mastoid has not begun 
to pneumatize and to assume the adult type 
and for that reason the very thin sinus 
plate of the infant can not be visualized on 
account of the compact, spongy bone struc- 
ture of the mastoid which lies over it. 

But when that bone structure is de- 
stroyed — not merely inflamed or softened — 
the sinus plate becomes visible on the 
radiographs of infants as young as three 
months, the youngest patient examined by 
me, and at operation a true mastoid abscess 
is found. By this I mean that after the 
cortex of the mastoid is removed a cavity 
filled with pus and debris is found which 
when cleansed out in most cases by merely 
wiping with gauze, reveals the sinus p’ate 
exposed to view. In a very small number 
of radiographs of patients under three 
years the sinus plate was visible when there 
was no destruction of the mastoid but in 
every instance a degree of pneumatization 
existed which was unusual, I may even say 
abnormal for that period of life, or the loca- 
tion of the sinus plate was abnormally 
superficial. These findings were confirmed 
by the operator in the very small number 
of these anomalous cases which went to 
operation. 

Since the beginning of this year through 
the co-operation of the House Staff of the 
Charity Hospital more than 30 infants with 


112 


Granger — Treatment of Infections of the Mastoids of Infants 


mastoiditis were treated with fractional 
doses of the roentgen rays with very 
gratifying results — again let me say that 
no cases showing the sign of destruction 
of the mastoid were treated, but only 
those with occlusion of the mastoid antrum 
with or without infection of the mastoid 
structure. 

The technic consisted in making radio- 
graphs of both mastoids two or three times 
a week until clinically and radiographically 
the condition cleared up or the signs of 
destruction became evident. The little 
patients received two or three fractional 
doses of the roentgen ray a week and at 
the same time we obtained the same num- 
ber of radiographic records of the progress 
of the mastoid pathology. The smallest 
number of treatments given before the dis- 
charge from the ear ceased in the cases that 
got well was one and the largest was seven. 

In quite a number of cases with bila- 
teral mastoiditis the beneficial effects of the 
roentgen rays were shown most convinc- 
ingly when the discharge from one ear 
would stop after one to three irradiations, 
and it required two or three more irradia- 
tions before the discharge from the other 
ear ceased, although the same local treat- 
ment had been applied to both ears from 
the beginning. 

A very constant and reliable indication 
that the diseased mastoid is responding 
favorably to these fractional doses of the 
roentgen rays is for a slight general re- 
action — rise of V 2 to 1 degree in tempera- 
ture — and local reaction, diminished pain 
and more profuse discharge, to take place 
in from 6 to 24 hours after the irradiation, 
followed the next 24 hours by a diminution 
in the quantity or a change in the quality — 


thinner and less purulent — of the discharge 
or both. 

ILLUSTRATIVE CASES. 

Case 1. L. M. F., baby girl, 10 months of age. 

June 4, 1930: There was a rise in temp, to 104°. 

June 6, 1930: Lung examination negative. 

June 9, 1930: Examination of ear revealed red 

bulging drums. Tympanotomy done and pus dis- 
charged from both canals. Temp. 103.5°. 

June 10, 1930: Ears still discharging pus. 

Temp. 103°. 

June 10, 1930: Roentgen examination shows 

occlusion of both mastoids. 

June 12, 1930: Ears still discharging pus. 

Temp. 101°. 

June 16, 1930: Ears still discharging slight 

amount of pus. Temp. 99.6°. 

June 16, 1930: Roentgen examination shows 

both mastoids clearing up satisfactorily. 

June 20, 1930: Irrigation of both ears returned 

clear. Temp. 99.6°. 

June 23, 1930: Discharge from ear drying up 

but typanum repunctured because of temperature. 
At this repuncture no discharge was obtained. 

June 23, 1930: Roentgen examination shows 

still further clearing up of the mastoids. 

Case 2. V. M., baby girl, 3 years old. 

August 30, 1930: Cold, pain in mastoid region, 

more severe on the left. Temp. 104°. Examina- 
tion of ears revealed bulging drums. Tympanotomy 
done, pus obtained from both ears. 

August 30, 1930: Roentgen examination shows 

occlusion of both mastoid antrii. with no evidence 
softening or destruction at this time. 

August 31, 1930: Ears still discharging pus,. 

Temp. 103°. 

September 2, 1930: Ears still discharging; more 
on left. Temp. 103°. 

September 4, 1930: Ears still discharging; more 
on left; the amount is decreasing. Temp. 100°. 

September 5, 1930 : Roentgen examination shows 
right mastoid clearing up ; left mastoid shows 
evidence of more pus with inflammatory reaction. 


Granger — Treatment of Infections of the Mastoids of Infants 


113 


September 8, 1930: Right ear irrigation clear; 

left ear still a discharge of thin watery pus. 
Temp, normal. 

September 9, 1930 : Roentgen examination shows 
right mastoid cleared up ; left mastoid shows 
evidence of pus and inflammatory reaction. 

September 12, 1930: Right ear discharge dried 

up; left ear still a small amount of discharge. 
Temp, normal. 

September 12, 1930: Roentgen examination 

shows right mastoid cleared up; left mastoid 
clearing up. 

Case 3. A. M. H., baby girl 2 years old, admitted 
to Charity Hospital, September 25, 1930, with per- 
foration of the right drum membrane, a profuse 
purulent discharge from the ear for the past week. 

September 27, 1930: T. 100.2°, E. N. T. con- 

sultation, discharge profuse. 

September 29, 1930: T. 100.4°. On this date 

the child had its first roentgen examination, the 
left mastoid was clear, the right side showed 
marked occlusion but no signs of breaking down. 
Discharge from the ear was profuse and solution 
returned cloudy with large particles of pus. 

September 30, 1930 : Routine therapy continued. 

T. 100°. Discharge nil; solution returned cloudy 
with large number of pus particles, adenopathy de- 
creasing in size. 

October 1, 1930 : Routine therapy continued. 

T. 99.4°. The solution returned cloudy with 
numerous particles of pus. 

October 2, 1930: Patient received the second 

dose of ray, no change in the condition of the 
mastoid as shown on radiograph. Solution re- 
turned cloudy with few particles of pus. T. 96.6°. 

October 4, 1930 : Patient received the third dose 
of ray. Solution returned clear with few particles 
of pus. 

October 6, 1930: Plates of this date showed no 

change in the pathology previously reported. 
T. 102°. At this time the patient developed an 
acute respiratory infection, slight cough, with 
sonorous and sibilant rales throughout the chest. 
Solution returned clear with numerous particles of 
pus. 


October 7, 1930: On this date for the first time 

there is radiologic evidence of the right mastoid 
clearing up. T. 101°. Irrigations clear and there 
is still moderate amount of pus returning. 

October 9, 1930: T. 99.6°. On this date the 

mastoids were reported as clearing up satisfac- 
torily. Small amount of drainage, few particles 
of pus returning. 

October 10, 1930: No discharge; solution re- 

turned with a few strands of pus. T. 98.8°. 

October 13, 1930: Solution clear and no dis- 

charge. T. 98.8°. 

October 14, 1930 : This was the last picture that 

was taken and the report stated a complete clear- 
ing up of the right mastoid. No discharge and 
solution clear. 

October 15, 1930: No discharge and solution re- 
turned perfectly clear. T. 98.2°. 

October 16, 1930: No drainage and solution re- 

turned clear. T. 98.8°. 

As there has been no discharge for the past 
eight days and solution has returned clear for the 
past four days, the patient was discharged and 
referred to the E.N.T. Clinic for further obser- 
vation. 

Case 4. E. G., baby girl, 6 years old. 

Both ears discharging for over three weeks fol- 
lowing measles. 

Radiographic examination on March 28 showed 
occlusion of both mastoids but no sign of softening 
or destruction. That evening the temperature was 
nearly a degree higher and the discharge more 
profuse. The next day the discharge became more 
watery and began to diminish. Within the week 
the discharge from the right ear ceased, and that 
from the left ear continued to lessen but there 
was still two or three drops of watery discharge 
during the day on May 9 when another radio- 
graphic examination was made. This showed the 
right mastoid clear, and the left mastoid cloudy, 
but without signs of softening or destruction. 

That night (May 9) the discharge from the 
affected ear (left) increased slightly and the fol- 
lowing day it began to diminish and had ceased 
entirely on the fifth day after the second raying. 


114 


Nicolle — The Schilling Index 


THE SCHILLING INDEX.* 

H. T. NICOLLE, M. D., 

Baton Rouge, La. 

The Schilling index or count is based on 
the development of the white blood cells. 
In order to better understand its value and 
limitations we have to consider first the 
development of the cells and their origin. 

Piney asks a very pertinent question 
when he says, “Is there somewhere in the 
body a type of cell capable of giving rise 
to all forms of blood cells? Or has each 
type of formed element of the blood an 
ancestor whose developmental possibilities 
are strictly limited by its own constitution?” 

It is this that has divided the hemetolo- 
gists into two main schools, viz : those who 
believe that all blood cells are derived from 
a single type of precursor, the monophyle- 
tists, and those who believe that there are 
two main types of manufacturing cells, the 
myeloblasts and the lymphoblasts for the 
granular and the non-granular cells. The 
monophyletic view is that all cells are de- 
rived from the reticulo-er.dothelial system 
and that, at any time during life, it can 
produce haemocytoblasts with the power of 
developing into any type of blood cells. 
“The only polyvalent haematopoietic ce’l is 
the reticulo-endotehhal one.” 

The moocyte or large mononuclear or 
endothelial leukocyte is hard to classify. It 
apparently springs from the reticulo-endo- 
thelial system according to some authori- 
ties. According to others it develops from 
the lymphocytes. Piney considers them to 
be derived from the myeloblasts. Maximow 
believes that the monocytes are derived 
from the lymphocytes during inflammatory 
processes, where they are transformed from 
lymphocytes to cells which cannot be dis- 
tinguished from monocytes and finally to 
polyblasts. “The facts, therefore, give a 
strong support to the idea that the mon- 
ocytes are simply lymphocytes, which 

*Read before Our Lady of the Lake Sanitarium 
Staff, Baton Rouge, April 22, 1931. 


under the influence of stimuli of unknown 
nature and in adaptation to a specific func- 
tion of probably defensive character, have 
progressively developed in a particular 
direction. The monocyte, accordingly, may 
bo looked upon as the polyblasts of the nor- 
mal blood.” This may occur in any part 
of the body but mainly in the stagnating 
blood which fills the large venous capillaries 
of the spleen, liver, bone-marrow and other 
organs. 

Schilling adds a third system for the 
monocytes to exp T ain the otherwise incom- 
prehensible independence of the monocytic 
system in the clinical picture. He believes 
that the monocytes are the only cells derived 
from the reticulo-endothelial system. He 
claims to have found all transitions from 
hystiocytes to monocytes. 

In the adult it is generally believed that 
the granulocytes are produced in the bone- 
marrow, the lymphocytes in the lymphatic 
tissues and. spleen, and the monocytes in the 
spleen, liver and bone-marrow. 

We will take each class separately. 

The granulocytes or granular leukocytes 
originate for practical purposes from the 
myeloblasts. These develop into myelocy- 
tes, then into metamyelocytes or juveniles. 
The nucleus of the mye’oeyte is oval with a 
regular edge. When the nucleus becomes 
indented, it is the metamyelocyte, young 
form or juvenile. As the nucleus shrinks 
further, it becomes rod or band shaped, and 
this type of metamyelocyte is then called the 
band, rod, or stab form. As further 
pyknosis occurs the nucleus becomes broken 
into several large knobs or segments con- 
nected together by a small thread and then 
we have the true segmented forms. This is 
conceded by practically all authorities as 
the development of the granular cells. This 
occurs in the neutrophiles, eosinophiles and 
fcasophiles. The different types of granules 
are formed early in the myelocytes. 

The platelets are, according to Wright, 
disconnected processes of the megakaryo- 


Nicolle- — The Schilling Index 


115 


cytes in the bone marrow. Petri does not be- 
lieve that this is their origin. According 
to Schilling, the blood platelet itself, is the 
entire modified nucleus of the younger 
erythrocytes, partly detached, and only be- 
coming free in the circu’ation. 

The classification of the cells according to 
their ages is approximately as follows : 

Lymphoblasts, large lymphocytes, small 
lymphocytes. 

Promonocytes, monocytes. 

Myeloblasts neutrophilic, myelocytes, 
juveniles, stab or band, and seg- 
mented. 

Eosinophilic myelocytes, eosinophiles. 

Basophi ic myelocytes, basophiles. 

The first to bring out a nuclear index was 
Arneth. He classified them as to the num- 
ber of lobes in the nucleus. Class 1, 5 per 
cent; II, 35 per cent; III, 41 per cent; IV, 
17 per cent ; V, 2 per cent. He then divided 
each class according to the number of knobs 
and S-like pieces of chromatin giving a total 
of 20 classes. 

This was modified by W. E. Cooke to five 
classes by only taking note of the connect- 
ing band between the different nuclei. He 
states that “if there is any band of nuclear 
material except a chromatin filament con- 
necting the different parts of the nucleus, 
that nucleus cannot, for the purpose of the 
count, be said to be divided.” 

As the Arneth count did not make any 
provision for the younger cells, it was modi- 
fied by Victor Schilling to include these and 
all adult segmented cells were placed in one 
group. He classified his cells for practical 
purposes as follows : 

Total White Count Basophiles, Eosinophiles, 


This he speaks of as a hemogram. 

Taking the polynuclears arranged in their 
proper rotation of myelocytes, juveniles, 
bands and segmented, a shift to the left 
means that there are more young ce'ls than 
normal. The greater the shift to the left 
the younger will be the cells. In a shift to 
the right, there is a diminution of the young 
cells in the blood or they may be totally 
absent. 

The number of immature cells is slightly 
higher in nurslings than in the adults. 

In order to properly identify the cells, a 
very good stain is required. Giemsa is gen- 
era ly used. This may be used alone or the 
slide may be previously stained with May- 
Grunewald or Wright’s stain. Giemsa 
brings out the nuclei and protoplasm while 
the May-Grunewald brings out the granules. 

In making the count, Schilling uses the 
four field meander method. 

The Schilling count has been used for 
diagnosis and prognosis in this laboratory 
for about eighteen months. I have found 
it very valuable both in diagnosis and prog- 
nosis. 

It has nothing to do with the total count. 
We may find a high count with a low Schil- 
ling and a !ow count with a high Schilling. 

For the purpose of evaluation of the blood 
findings, I personally prefer to have a com- 
plete hemogram which gives me the total 
red and white counts, hemoglobin, color 
index, differential count with Schilling 
count, platelet count, and the types of im- 
mature cells in the blood. This latter takes 
into consideration the immature cel’s in the 
neutrophil es, lymphocytes, monocytes and 
any other that may be found. This last tells 
us the condition of the cell manufacturing 
centers and how much reserve we have at 
any given time. 

Mye. Juv. Bands, Segm. Lymphocytes, Monocytes 
Polynucleai's 

0 0 4 63 32 

( 3 - 5 ) ( 58 - 66 ) ( 21 - 25 ) 


6,800 


.5 

( 0 - 1 ) 


3 

( 2 - 4 ) 


6 

( 4 - 8 ) 


116 


Nicolle — The Schilling Index 


Schilling divides the blood phases of in- 
fections as: — 

(1) The neutrophilic battle phase; (2) 
The phase of monocytic defense or subjec- 
tion and (3) the phase of lymphocytic cure. 

His rules are as follows: 

(1) Slight irritations cause only func- 
tional changes in the leukocytic picture; 
medium irritations act through the leuko- 
poietic organs ; severe irritations also act 
upon the development of the individual cells, 
very severe irritations restrain through 
paralysis of the central, and destruction of 
the central and peripheral cells. 

(2) In most of the infectious processes, 
the neutrophiles respond to the irritation 


first, then the monocytes, finally the lympho- 
cytes ; the difference in the infectious blood 
pictures is caused by the temporary shift 
of three phases and by the varying inten- 
sify of the reaction of the individual 
groups, or by the appearance of rarer cell 
forms. 

However, the blood pictures must always 
be observed together with complete clinical 
findings. 

A definite and certain clinical symptom 
must never be disregarded because of a 
negative blood picture; nor should marked 
blood findings be disregarded because of 
absence of clinical symptoms. 


SOME SCHILLING EXAMPLES 
R. B. Pneumonia, Adm. 4/12/31 Died 4/14/31 


Total 

White 

4,850 

B 

0 

E 

0 

M 

0 

J B 
4 84 

Seg. 

3 

L. 

6 

M 

3 

Immature count 

88 

R. M. 
Date 
3/10 

Tuberculosis, arrested. 
WBC 

7,400 0 0 

3 

91 

0 34 

34 

24 

5 

Influenza 

34 

3/31 

6,550 

0 

0 

0 

71 

0 17 

45 

31 

7 

In bed 

17 

4/7 

7,300 

0 

1 

0 

62 

0 16 

51 

34 

8 


16 

4/14 

5,300 

0 

3 

0 

57 

0 21 

31 

36 

9 

Lost 1 lb . in week 

21 

4/22 

6,825 

0 

4 

0 

52 

0 10 

45 

33 

8 

Gained 2 % lb s. 


J. P. 
4/15 

V. Traumatic 
20,925 

Pneumonia, right. 

0 0 1 2 23 

55 

9 

9 

S. C. 

26 

4/16 

19,550 

0 

0 

0 

81 

1.5,22.5 64 

6 

6 


24 

4/17 

13,700 

0 

0 

0 

88 

3 12 

73 

11 

1 


15 

4/18 

9,025 

1 

0 

0 

88 

2 16 

68 

10 

3 


18 

4/21 

12,300 

0 

4 

0 

86 

1 8 

67 

17 

3 




76 


Miller — Conservative Gynecology 


117 


CONSERVATIVE GYNECOLOGY: 

Its Rationale and Its End Results.* 

C. JEFF MILLER, M. D., 

New Orleans. 

I have quoted many times before, and I 
expect to quote many times again, a wise 
remark of Howard Kelly’s, to the effect 
that surgery, developing in the hands of 
men, has dealt too lightly with mutilating 
operations in women, and that if the case 
might be reversed for several decades, with 
women operating and men suffering the 
mutilation, there would undoubtedly be a 
large prepossession in favor of a wise 
conservatism. His comment, made many 
years ago, is still timely, for gynecology, 
in the modern phrase, has “gone surgical.” 
There is a general tendency to resort to 
operation without a careful consideration of 
simpler measures which would be quite as 
effective for the patient, and very much 
safer. There is a general tendency to re- 
move the female sexual apparatus, in whole 
or in part, on promiscuous and casual 
indications which, in another part of the 
body, could only be considered trivial. 
There is a general tendency, since the 
ablation of the genitalia is not a procedure 
which carries an inordinately heavy risk, to 
disregard the fact that a woman’s whole 
scheme of existence takes its point of de- 
parture from her pelvic organs. 

Conservatism, however, is an entirely rel- 
ative term. Its implications vary in differ- 
ent ages. A century ago it was conserva- 
tive to refrain from all surgery except such 
as was absolutely lifesaving, and hundreds 
of women died from uterine and ovarian 
tumors which today the least radical of 
gynecologists would feel warranted in re- 
moving on the simple indication of their 
presence. Seventy-five years ago, when 
operation for such conditions had been gen- 
erally accepted, it was conservative to re- 
sort to it only when the tumor was very 


*Read at the sectional meeting of the American 
College of Surgeons, Little Rock, January, 1931. 


large or the patient had suffered a good 
deal. Fifty years ago it was conservative 
to treat uterine fibroids by oophorectomy, 
a procedure little short of barbarous to us 
of this age. 

Plainly it is a case of other times, other 
manners. But at that, it is not always easy 
to define conservatism. There is no such 
thing as an operation which is fundament- 
ally conservative, even though, speaking 
categorically, preservation of structure and 
function is always to be preferred to their 
ablation. Circumstances alter cases, and a 
sense of proportion is necessary in the eval- 
uation of any procedure, though it must be 
constantly borne in mind that a perfect sur- 
gical result, desirable though that be, is 
never the only result, for when a woman’s 
pelvic organs are in question, function, 
other things being equal, deserves quite as 
much consideration as do mortality and 
morbidity. 

Social and economic factors likewise play 
an important part in the management of 
gynecologic conditions, and I have little 
patience with the surgeon who boasts that 
they never enter into his calculations. It 
would be much better for all concerned if 
they did. It is undoubtedly unfair that a 
woman of leisure, in an adequate financial 
environment, should be permitted a conser- 
vatism which a wage-earning woman, a 
woman in straitened circumstances, a 
mother of many children, or even a woman 
of limited intelligence, cannot possibly be 
permitted, but those are the facts. A con- 
servative operation which entails the risk 
of secondary surgery later may be entirely 
justified in a young, well-to-do, recently 
married woman, but it would not be justi- 
fied in a woman approaching the meno- 
pause, a woman who is the mother of a fam- 
ily, or a woman whose livelihood depends 
upon her own exertions. 

We meet such problems in our private 
work only too frequently for our peace of 
mind, but we meet them much more often 
in public practice. I meet them particu- 


118 


Miller — Conservative Gynecology 


larly often on my colored service at Charity 
Hospital, as does every surgeon who deals 
with colored women. To take a single illus- 
tration : these patients are especially sus- 
ceptible to gonorrheal pelvic infections, for 
which the accepted treatment is prolonged 
rest, isolation from the source of infection, 
and surgery only when conservative meas- 
ures have failed and symptoms continue to 
recur. I am in hearty accord with these 
principles, as I shall point out shortly, and 
I applaud the excellent results of the gyne- 
cologists who employ them. But as far as 
my colored service is concerned, they are 
utterly impractica 1 and utopian. These 
patients can often be cured symptomati- 
cally, even when their pelves are anatomi- 
cally wrecked, if I may so express it, by fol- 
lowing the regimen I have just outlined, but 
their cure is seldom permanent. In the 
majority of cases, if we discharged them at 
this stage, they would return to us at a later 
period, and to the charge of the state, with 
the same pathology in an even more aggra- 
vated form. The unhygienic conditions 
under which they live, their dependence 
upon their own efforts, make it quite impos- 
sible for them repeatedly to lose time from 
their work or their families, while their 
lowered moral sense and their limited intel- 
ligence make it eaual'y impossible for them 
to protect themselves against re-infection. 
We must choose between operating before 
our better judgment dictates, or permitting 
them to leave the hospital in little better 
condition than when they entered it. As a 
rule, therefore, when we have cooled them 
down, when the criteria of the delayed oper- 
ation have been met, we operate on them 
prompt 1 y, we clear out their pelves thor- 
oughly, and we consider ourselves conser- 
vative, radical though we may seem. What 
is desirable and possible on a private service 
may be equally desirable but quite impos- 
sible on a public service, and we simply 
stultify ourselves by refusing to face the 
facts. 

On the other hand, the whole problem of 
pelvic infection is an excellent example of 


the case for conservatism. For the last 
twenty years, since Simpson first advocated 
the method, expectant treatment has been 
rather generally the rule, but recently the 
pendulum has been swinging to the other 
extreme again, and we have had a plea for 
immediate operation made by a group of 
men whose brilliant individual results, at 
least from the standpoint of their imme- 
diate mortality, I unhesitatingly grant, 
though their arguments otherwise seem 
rather specious. 

In the first place, a certain percentage of 
these patients, even in the co'ored race, will 
always recover spontaneously and the first 
attack will be the last. Certainly abdominal 
section under such circumstances cannot by 
any process of reasoning be regarded as 
conservative, quite aside from the fact that, 
when immediate operation is done, complete 
pelvic debridement, which is an extremely 
radical procedure, is usually necessary. I 
grant the argument that a woman who has 
had an attack of gonorrheal salpingitis is 
very likely to be sterile thereafter, but even 
at that, I cannot see that she is any more 
absolute 1 y sterile than is her sister whose 
tubes have been removed at laparotomy 
during an acute attack. I would remind 
you, too, that statistics for expectant treat- 
ment show a 10 to 12 per cent chance of 
subsequent pregnancy, a possibility which 
immediate operation automatically elimin- 
ates. As to the conservative procedures 
supposed to be practical if immediate opera- 
tion is done, few positive results from them 
have been reported, and recurrent pelvic 
disease and extrauterine pregnancy are not 
rare sequelae. It cannot be gainsaid that 
when radical treatment is instituted, these 
women — and most often they are young 
women — emerge from the operation in the 
vast majority of cases functionally de- 
stroyed, and frequently facing in addition 
the distressing symptoms of a premature 
menopause, which is always stormy in pro- 
portion to the youth of the patient. 

In the second place, radical treatment, 
despite the excellent showing of Bonney, 


Miller — Conservative Gynecology 


119 


DuBose and their chief followers, will in- 
crease the mortality of pelvic disease many 
times. Under this plan it was formerly as 
high as 20 per cent, and recent studies show 
that 90 per cent of the operative mor- 
tality for tubal disease and 75 per cent of 
the postoperative morbidity still occur in 
patients who have not been properly cooled. 
These are collective figures, and they are 
therefore more to be relied on than the 
figures of the authorities I have just 
quoted, for it must never be forgotten that 
the bulk of all surgery is done, not by sur- 
geons of eminence, but by men of average 
ability, or, to speak bluntly, of small 
ability, whose disregard of established prin- 
ciples is likely to meet with swift and 
certain retribution. 

Finally, the patient herself should have 
some say in the matter of what is to be 
done to her. Her chances of a clinical cure 
under expectant treatment are reasonably 
good, her chances of a functional cure are 
decidedly more dubious, but if she under- 
stands the circumstances, if she is so 
situated that she can take the risk, she has 
a perfect right to take it. It is quite pos- 
sible that she may prefer to retain her 
pelvic organs, damaged though they be, on 
the analogy, as Chipman puts it, that half 
a loaf, and a painful loaf at that, is better 
than no bread. She is the best judge of her 
own desires and her own condition. If any 
patient of mine considers herself well, if 
she is able to resume her normal habit of 
life and to do her daily work with only 
brief periods of disability, I am quite ready 
to agree with her that she is well, even 
though the pelvic findings may not be 
entirely to my liking. A woman’s sexual 
organs are the basis on which her whole 
life is founded, and her sexual sanctity — I 
feel very strongly in this regard — should 
be violated only in the face of an urgent 
need. Which need, I might add, a single 
attack of salpingitis rarely constitutes. 

When once the necessity for operation 
has been established, however, then radi- 
calism becomes conservatism. When the 


abdomen has been opened, if the disease is 
specific or tuberculous, then bilateral sal- 
pingectomy is the only procedure which can 
guarantee against its recurrence. In tubal 
disease, almost more than in any other 
pathology, the sanest surgeon, the safest 
gynecologist, is he who refrains longest 
from the practice of his art, but who, when 
obliged to exercise it, tempers his con- 
servatism with sufficient radicalism to 
ensure for his patient a permanent cure. 

But his ruthlessness must not be ex- 
tended to organs not involved in the 
infectious process. Routine removal of the 
ovaries, for instance, after either salpingec- 
tomy or hysterectomy cannot be too strongly 
condemned. In pelvic disease of specific 
origin the ovary is frequently not essen- 
tially diseased, it has simply been in bad 
company, and its conservation is always 
indicated if it seems likely that extirpation 
of the primary focus of infection will re- 
lieve its acquired pathology. If the ovary 
is essentially diseased, on the other hand, 
the situation is very different, and 
oophorectomy is usually indicated. Resec- 
tion simply paves the way for future 
troub’e, and while ovarian grafts are useful 
in a small percentage of cases, their field 
is very limited indeed. I am aware that 
the final facts are still in dispute as to the 
fate of cor served ovaries, but until we 
know more of their part in the internal 
economy after the menopause, we should 
not remove them without due cause, quite 
aside from the fact that excellent results 
from the conservative method are reported 
by many competent authorities. 

I do not hold, either, with the routine 
removal of the uterus simply because the 
tubes have been removed for specific dis- 
ease. If it is intrirsically diseased, 
hysterectomy must natura’ly be done, but 
otherwise I do not see the logic of the 
procedure. For one thing, it adds, un- 
questionably, a definite if minimal risk to 
the operation. For another, it ends men- 
struation forever, and though that function 
is the curse of the female sex, most 


120 


Miller — Conservative Gynecology 


women are perverse enough to desire its 
continuance, even when the more impor- 
tant function of conception cannot occur. 
Sampson’s recent studies in post-salpingec- 
tomy endometriosis would seem to put a 
different complexion on this subject, but I 
have not yet seen such sequelae in sufficient 
numbers to make me change my views on 
the preservation of the uterus after re- 
moval of the tubes. 

We have come very far from the surgeon 
who, as late as 1886, said, “I shrink and 
have a feeling of terror come over me when 
I find myself obliged to do a hysterectomy,” 
but it might not be altogether a bad thing 
if there were some such feeling of fear 
abroad in surgical circles today. For 
hysterectomy has become the most abused 
operation in gynecology. It is still being 
performed for the so-called essential uterine 
bleeding, though it is not warranted in 
one case in a hundred, since the uterus 
is simply responding to the evil stimulation 
of dysfunction elsewhere. It is still being 
performed for uterine bleeding when the 
trouble is extrauterine and even extra- 
pelvic. It is still being performed, though 
I grant usually unintentionally, for bleeding 
that has its origin in some complication of 
pregnancy. 

Hysterectomy is often performed very 
unnecessarily for uterine fibroids, for 
which either myomectomy or irradiation 
should always be first considered if the 
tumor does not fall into that small group 
of symptomless growths which need no 
treatment at all. Myomectomy is an opera- 
tion which, at least in private practice, 
has a wider field than is generally supposed. 
In competent hands the mortality and mor- 
bidity are no higher than they are in 
hysterectomy, and from the standpoint of 
both the menstrual and the child-bearing 
function the end results are extremely good. 
On the other hand, it is not conservatism, 
it is the height of unwisdom to perform it 
if the uterine musculature is seriously 
damaged either by the existing pathology 


or by the surgery necessary to remove the 
growths, and it should likewise not be per- 
formed if the appendages must be removed 
for tubal or ovarian disease, or if the 
woman is at or near the menopause. 

Irradiation is another procedure which 
can be either conservative or radical. 
Since it most often means the complete de- 
struction of function, it is seldom the elec- 
tive treatment for fibroids in women under 
forty, though it is the ideal method for 
selected cases after that age, as well as for 
the menorrhagias of ovarian origin. Even 
in young women and in girls, though it is 
frankly a last resort, it can be used in 
graduated doses to check uterine bleeding 
and produce a temporary amenorrhea. As 
Howard Kelly says, it is notoriously diffi- 
cult to terminate menstruation in early life, 
even when that is the aim, and he adds that 
the advocates of surgery certainly possess 
no magic by which they can extirpate the 
uterus and at the same time preserve func- 
tion. In the rare instances in which grad- 
uated irradiation fails, then hysterectomy is 
to be preferred to a menopausal dose in 
young women, for very serious conse- 
quences may follow the abrupt ablation of 
ovarian function by the use of radium or 
the roentgen-ray. 

Hysterectomy for hydatidiform mole has 
always been an unwarranted procedure. 
The disease is relatively rare, and chorio- 
epithelioma as a sequel is even rarer; 50 
per cent of such malignant tumors are 
preceded by moles, but the reverse of the 
statement, often advanced as a fact, is 
positively not true ; 50 per cent of moles do 
not develop into chorioepithelioma. Even 
in the days when microscopic study of the 
uterine scrapings, which is admittedly an 
unsatisfactory and inconclusive procedure 
in this special disease, was the chief diag- 
nostic resort, immediate hysterectomy was 
scarcely justified, and now that the Asch- 
heim-Zondek test has given us a practically 
infallible diagnostic measure, there is no 
excuse for it whatsoever. 


LeDoux — Senile Vulvitis and Vulvo-Vaginitis 


121 


Time does not permit me to discuss other 
conditions and other procedures. I cannot 
do more than point out that the curette, that 
much maligned and much abused instru- 
ment, can, if properly employed, avert 
many radical and serious and unnecessary 
operations. I cannot do more than point 
out that diseases of the cervix should be 
handled far more frequently by prophylac- 
tic cauterization promptly after labor than 
by delayed surgery, and that, if surgery 
must be done, trachelorrhaphy, or the 
Sturmdorf or the Schroeder operation, all 
of which are usually possible after proper 
preparatory measures, should be done far 
more frequently than amputation with its 
chain of evil consequences. I cannot do 
more than point out that retroversion of 
the uterus is not, per se, an indication for 
a displacement operation, and that surgery 
should be done only when it is clear that 
the symptoms complained of are the proven 
result of the malposition. I cannot do more 
than point out that endometriosis intro- 
duces a most delicate problem, and that in 
its management radicalism and conservat- 
ism are divided only by the narrowest of 
lines. 

The conclusion of the whole matter 
obviously does not lie in categoric classifi- 
cations. The simplest procedure may be 
at times a very radical one, the most radical 
procedure may be at times true conservat- 
ism. The important consideration is that 
not only the immediate but the end results 
of every mode of treatment shall be evalu- 
ated; not only operative mortality but ulti- 
mate function ; not only the patient’s physi- 
cal well-being but her mental and spiritual 
equilibrium. For gynecologists, beyond all 
other physicians, hold the happiness of 
women in their hands quite as much as 
their lives and their health, and it behooves 
them to take earnest heed that they pre- 
serve them all alike. 


SENILE VULVITIS AND VULVO- 
VAGINITIS, 

With Special Reference to Trichomonad 
Vaginalis Infection.* 

LUCIEN A. LeDOUX. M. D., 

New Orleans. 

The vulvitis and vulvo-vaginitis, non- 
specific in character which is frequently 
noted after the menopause, presents several 
features of unusual interest, and is there- 
fore worthy of more than casual con- 
sideration. 

The origin of this disturbance in these 
types of cases, is too frequently taken to 
be the result of a common leucorrheal in- 
fection, and insufficient study and a lack of 
appreciation of the possible underlying 
causes, often accounts for the failure to 
achieve permanent results in its treatment. 

The cessation of the sexual physiologic 
life in the female, is evidenced in many 
ways, one being the gradual atrophy of the 
sex structures, the vulva showing marked 
changes, the mons-veneris losing its firm- 
ness and adipose tissue; similar changes 
appear in the labia and sebaceous glands, 
resulting in the loss of tissue elasticity 
and lubrication. These changes are noted 
especially in women who have reached the 
menopause at a later period than the aver- 
age and who may have been classed during 
their active life as of the hyperthyroid 
type. 

These tissue changes produce a type of 
dermatitis, which appears to be greatly 
aggravated by the sensory changes which 
are typical of the general changes in the 
nervous system at that time, and the result- 
ant irritation is very disagreeable and at 
times becomes very painful, producing in 
extreme cases a complete demoralization of 
the individual with loss of appetite and 
weight, sleeplessness and acute nervous 
system upheavals, all of which should 

*Read before Orleans Parish Medical Society, 
January 26, 1931. 


122 


LeDoux — Senile Vulvitis and Vulvo-Vaginitis 


serve to emphasize the fact that cases of 
this type, should not be dismissed with a 
prescription for calamine lotion, and in- 
structions to take a daily hot sitz bath, for 
while these are helpful, they are not 
sufficient. 

Senile vuvitis is generally unaccom- 
panied by a vaginal discharge; if it is, it 
is unusually slight, therefore treatment 
should be directed to relieving the general 
menopause symptoms as well as attempting 
to allay the local irritation. 

The institution of vigorous hygienic 
measures, with emphasis on the rehef of 
constipation, sedatives, my choice being the 
bromide of sodium in sufficient and frequent 
doses, iron, strychnine and arsenic, endo- 
crine therapy as indicated in the particular 
case, using the specific harmones separately, 
never in combination, usually lutein or 
thyroxin or both, the kneechest position to 
improve the pelvic circulation, the ingestion 
of large amounts of water, and a diet which 
tends to be slightly greater than normal 
in fats. 

The local treatment should consist of 
hydro-therapy in the form of sodium bicar- 
bonate hot sitz bath, pure coM cream with 
the addition of phenol, menthol, and in some 
cases cocaine hydrochloride, anointing the 
vulva, particularly the labia, freely, at 
least three times daily, and also the use of 
the sun lamp. 

When the dermatitis is exfoliative, care- 
ful c’eansing with the tincture of green 
soap, followed by the application of zinc 
oxide ointment will afford much relief. 

Such a plan of treatment will do much 
to correct the disability in these types of 
cases. 

In vulvo-vaginitis we have the typical 
appearing leucorrheal discharge, but in 
some cases, while it is yellowish white, it 
presents in addition a frothy appear- 
ance, as though filled with air bubbles, 
this is often noted upon separating the 


labia or after further examination with 
the speculum. 

This produces at times a vulvitis and 
vaginitis, the vaginal mucous membrane is 
inflamed, as is the cervix, the latter show- 
ing small, various shaped ulcerated areas. 
The surface bleeds easily to the touch and 
it may be very painful. 

Examination of this discharge by the 
usual methods of staining and preparation 
will not reveal the offending organism in 
such cases, but examination in the fresh, 
wi 1 demonstrate the presence of a large 
number of flagellates identified as the 
trichomonad vaginalis. 

Infection with this type of organism is 
not infrequent, it may occur at any time 
during the sexual life of the female, and 
is often the causative factor in the pro- 
duction of vulvo-vaginitis after the meno- 
pause. 

Whether this organism is truly path- 
ogenic or saprophytic, I am unable to say; 
I have found this infection in women after 
the menopause, during long, lingering ill- 
nesses and pregnancy, periods of relative, 
sexual inactivity, which suggests that it is 
a saprophyte, though, as I have already 
mentioned, its presence has also been de- 
tected in other periods of life. 

The organism is associated with evidence 
of desquamation, of varying degrees, with 
pus cells present, and at times, few if any 
other organisms. 

The pathogenic changes resulting from 
its activity is often intense, at other times 
mild, and it is an infection, while easily 
controlled, nevertheless difficult of complete 
eradication. 

A search for the trichomonad vaginalis 
should never be made immediately after 
douching or while the patient is receiving 
active, local treatment, as these mitigate 
against successful diagnosis. Likewise, the 
presence of blood in the vaginal tract 
seems to lessen our ability to find the 


LeDoux — Senile Vulvitis and Vulvo-V aginitis 


123 


organism, a circumstance for which I can 
offer no plausible explanation. 

Given such a case, if the usual methods 
of treating leucorrhea are employed, the 
infection will be controlled to an extent, 
but any semblance of a cure can not be 
anticipated, as it positively resists our 
ordinary efforts. 

I have seen a number of cases, of two 
or three years duration, labelled as simple 
leucorrhea, without microscopic examina- 
tion, complaining of severe symptoms, 
shortly after douching and other local 
treatments has been discontinued. 

The method of treatment that I have 
used is briefly as follows: When I first 

attempted the treatment of these infec- 
tions, I routinely irrigated the vagina with 
sodium bicarbonate solution, and cleansed 
thoroughly with tincture of green soap. 
Afterwards the field was thoroughly dried 
and the full surface treated with a 2 per 
cent solution of mercurochrome. After 
drying, the patient was instructed to take 
a vaginal douche, using one drahm of 
powdered zinc sulphate to a quart of warm 
water, twice daily. Zinc oxide ointment 
was then applied with a tampon every 
other day for a period of eight or ten days 
and the relief afforded by this method of 
treatment was conclusively better, but by 
no means complete, as in a number of cases, 
subsequent examination revealed continued 
infection. 

In recent month I have had occasion to 
supplement this treatment, with vaginal 
application of a solution of pyroligneous 
acid, and using Lassars paste, which is 
composed of salicylic acid, zinc oxide, 
starch and petroleum, as a tamponade, 
every other day for two or three treatments. 

This was a suggestion offered by 
Dr. S. G. Kleegman, S. G. 0., October, 1930, 
who has had considerable experience in the 
treatment of this disease, and she reports 
on controls of cases showing cures in 85 
per cent of her cases. It appears, there- 


fore, that we have the necessary medical 
aids in caring for this problem, yet a cure 
cannot be claimed until the patient has been 
without treatment of any kind for at least 
four months and successive examinations 
are negative. 

CONCLUSIONS. 

(1) Simple, non-inf ectious vulvitis after 
the menopause, should be treated both 
locally and systematically. 

(2) Trichomonad vaginalis infection is 
frequently the cause or sustaining cause of 
vulvo-vaglnitis after the menopause. 

(3) Every case should be studied micro- 
scopically, using a fresh specimen as the 
usual method of staining are of little 
value. 

(4) Treatment should be thorough and 
controlled by microscopic examination. 

(5) Four months without treatment and 
repeated negative examination are neces- 
sary before assuming that the infection is 
non-existent. 

DISCUSSION. 

Dr. F. M. Johns (New Orleans) : Dr. LeDoux 

has undoubtedly requested me to open this dis- 
cussion to present my views concerning 1 the path- 
ogenicity of the trichomonad vaginalis in relation 
to vaginitis, as we have on several occasions dis- 
cussed this problem. 

I feel quite certain that these protozoan para- 
sites do not directly invade the mycosa of the 
vagina, rectum or large intestine upon whose 
surfaces they may very often be found. Reproduc- 
tion of these protozoa takes place in the fluids 
bathing these mucosal surfaces and have not been 
demonstrated in tissue sections. They multiply to 
great numbers if the fluid is rich in albuminoid 
material as it always is in the presence of in- 
flammation of the mucosa from any cause whatso- 
ever. In the vagina they occasionally thrive on 
the exudate poured into that cavity from a 
chronically inflamed uterus, and in some of these 
instances there is no demonstrable viginitis. 

It is conceivable that some toxic material may 
be formed as an excretion product or liberated 
from those protozoa that die and disintegrate. 
This has never been proven. It is, however, 
almost certain that if trichomonads are present in 
any considerable numbers in any of the body 


124 


Naef — Post-Encephalitic Epilepsy 


cavities there is certainly an inflammatory condi- 
tion present that definitely needs treatment. 

It was rather amusing to see in a recent num- 
ber of S. G. and O. an article on trichomonad 
vaginitis illustrated with a cut containing several 
parasites with four flagella each! The clinical 
deductions made by this author are probably just 
as correct as the picture. 

Dr. LeDoux (closing) : There is not very much 

to add but I do want to thank Dr. Johns for his 
very excellent discussion. 

Whether trichomonas itself is capable of pro- 
ducing these changes or not I do not know, but 
it appears from a study of these cases that the 
leucorrheal discharge having already begun as a 
result of bacterial infection, trichomonas seems to 
be the sustaining influence in the continuance of 
the discharge and unless we keep in mind the 
necessity of eradicating ^he sustaining influence, 
as well as the predisposing cause, we are going 
to have a continuance of the infection for an in- 
definite period. 

POST-ENCEPHALITIC EPILEPSY, 

With a Report of Two Cases in 
Childhood.* 

EMILE NAEF, M. D., 

Baton Rouge. 

Epidemic encephalitis and its sequelae 
have been extensively described in the 
medical literature of practically every 
country since its initial appearance in 
Vienna in 1917 and its subsequent appear- 
ance in New York in March, 1918. Von 
Economo, observing the earliest cases in the 
Austrian epidemic, recognized a group of 
symptoms of sufficiently typical character- 
istics to be classed as a separate clinical 
entity and contributed the first descrip- 
tion of the syndrome appearing in the 
literature. The assumption that epidemic 
encephalitis existed previously is well 
founded, a somewhat similar epidemic 
called “La Grippe Cerebrale” by the 
French writers having appeared in all parts 
of the globe in 1892. Much of the earlier 
writing on epidemic encephalitis was de- 
voted entire’y to description of the acute 


*Read before the Louisiana State Pediatric 
Society, April 13, 1931. 


stage of the disease and the etiology, while 
latterly the pathology and sequelae are 
given more attention. 

Epidemic encephalitis, while frequently 
affecting children, is not predominantly a 
childhood disease. Hall, 1 in 1925, reporting 
his observations on 500 cases at all ages, 
found about 40 per cent occurring in per- 
sons under 16 years of age. However, it 
may occur at any age, one case being 
reported in a newly-born whose mother was 
ill with the disease at the time of labor. 

The disease is essentially a winter or 
early spring disease, occurring at a season 
of the year when influenza is prevalent, 
and virulent organisms may be implanted 
in the throats of individuals not actively 
manifesting symptoms of influenza. This 
fact opens an etiological point of obser- 
vation, though whether the disease is caused 
by a pleomorphic form of the influenza 
bacillus, by a filterable organism not yet 
differentiated, or by the activation of some 
latent infection, remains to be established. 
Gorter 2 thinks it improbable that encepha- 
litis is ever caused by any activation of a 
latent infection. Throckmorton, 3 however, 
is convinced that once the disease is con- 
tracted, it may become latent, with acute 
manifestations flaring up after prolonged 
intervals of entire freedom from the dis- 
ease. Price 4 reports a recurrence in a 
patient one and one-half years after re- 
covery, and attributes the return of 
symptoms to a “probable recrudescence of 
encapsulated infectious foci, rather than a 
reinfection from an outside source.” 

Several salient features of encephalitis 
have become well established facts, among 
which is the definite infectiousness of the 
disease, but with less tendency to appear in 
epidemic form than was formerly supposed, 
many sporadic cases being reported from 
widely scattered districts. 

Another well-established fact is that the 
disease may attack any part of the central 
nervous system from the brain to the spinal 


Naef — Post-Encephalitic Epilepsy 


125 


cord, the basal ganglia and the brainstem 
being most frequently involved. 

Our further knowledge of the disease re- 
veals the fact that so multiple and varied 
are the symptom-complexes that many cases 
defy complications in spite of persistent 
attempts to classify them. The lethargic, 
the paralysis agitans type, the polioence- 
phalitic, the acute anterior poliomyelitic, 
the posterior poliomyelitic, the epilepto- 
maniacal, and the acute psychotic type 5 are 
types of the disease encountered, though 
many cases could meet the requirements of 
two or more of these types depending on the 
multiplicity of the symptoms and signs 
presented. 

Fairly typical laboratory findings are 
encountered in epidemic encephalitis when 
evaluated in conjunction with the neuro- 
muscular signs and the course of the dis- 
ease. The blood usually shows a moderate 
total leukocytosis, the clifferential count ap^- 
proaching normal. The spinal fluid is usually 
obtained under pressure, and in my experi- 
ence, has practically always been obtained 
under increased pressure, though some 
writers claim increase of cerebro-spinal 
pressure in only 10 per cent of these cases. 
The fluid is clear and limpid with a normal 
or slightly increased globulin and albumin. 
The frequently reported increase in sugar 
is dependent on the carbohydrate intake, 
the amount of sugar in the spinal fluid 
being normal if the specimen is collected 
after a 12-hour fast. 6 These findings bear 
a close resemblance to the findings in 
poliomyelitis, though poliomyelitis shows a 
more constant and marked increase in 
neutrophiles and globulin, with more ten- 
dency to pellicle formation. Any marked 
abnormality of the spinal fluid findings 
immediately suggests a meningitis. 

Sequelae of some kind occur in from 
80 to 90 per cent of these patients, depend- 
ing on the amount of damage to the cells of 
the central nervous system, which however 
bears no relation to the severity or mild- 
ness of the symptoms during the acute 
stage. The sequelae fall chiefly into two 


main groups : the behavior disturbances and 
the parkinsonian-like syndromes. 7 

The mental sequelae or behavior disturb- 
ances of encephalitis present themselves in 
every degree of severity from the compara- 
tively mild “difficult child” type to the 
dreaded extreme of complete idiocy, while 
rarely manic depressive insanity remains as 
a sequel. The difficult child is one who does 
not respond to discipline, lacks concentra- 
tion and is readily fatigued by slight 
mental effort; whose emotions are usually 
dulled and frequently has completely dis- 
oriented himself in relation to sleep, being 
dull and sleepy during the day, and wakeful 
and restless at night, often talking loudly, 
whistling, and singing during the period of 
insomnia. He wears the expressionless 
facies of facial paralysis and registers little 
emotional response to external stimuli. 
Exophthalmos, more apparent than real 
(because of staring expression and widened 
palpebral fissures) is sometimes found. 
Between this dull, retarded type and post- 
encephalitic idiocy appear the cases of com- 
plete character change, where children 
formerly well-behaved become sneak thieves 
and falsifiers, develop habits of wandering 
from home, engage in street fights, become 
filthy in personal habits, sometimes exhibit 
precocious sexual tendencies, and rarely 
manifest homicidal or suicidal mania. The 
post-encephalitic idiot drools saliva almost 
continuously, articulation is difficult and 
speech becomes heavy and monosyllabic; 
habit-tics are frequent; lack of sphincteric 
control may be present, and finally a com- 
plicating parkinsonism may be present, 
further typifying this class of unfortunate. 

The neuromuscular sequelae include the 
much - described parkinsonism, epileptoid 
states or frank epileptic seizures, ataxia 
and chorea, while hemiplegias, paraplegias, 
and monoplegias, often described in the 
earlier literature of encephalitis, are rarely 
mentioned sequels in the more recent 
writings. Kennedy 8 reports parkinsonism 
in 34 per cent of a series of 61 cases. 
Anderson, 9 however, found it occurring only 


126 


Naef — Post-Encephalitic Epilepsy 


once in forty of his cases. The ocular 
manifestations — forced conjugate upward 
movement of the eyes — appear as a part of 
the post - enchephalitic parkinsonian syn- 
drome, these ocular spasms having been 
first described by Holman in 1925. In 
these cases the mechanism affected lies in 
the corpus striatum and its connections 
with the anterior quadrigeminal bodies and 
the oculomotor type. A rare type of post- 
encephalitic residual is a spasm involving an 
extremity, described in 1924, by Lemos, 10 
who designated it intermittent claudication. 
In the case described, cramps of the muscles 
of mastication and of the arms appeared, 
together with conjugate deviation of the 
head and eyes, regarded by the author as 
due to a crisis of extra-pyramidal hyper- 
tonia probab 7 y based on a lesion occurring 
in the corpus striatum. Throckmorton re- 
ported a case in a 21-year adult in whom 
three distinct attacks of epidemic encepha- 
litis appeared, the most recent one being 
complicated by spasms involving the right 
arm and leg — more especially the arm — and 
at times causing conjugate deviation of the 
head and eyes with spasm of the facial 
muscles, but with no loss of consciousness, 
thereby presenting a typical Jacksonian 
epilepsy. 

Epilepsy and the epi’eptoid states occur 
as residuals of epidemic encephalitis in 
a small percentage of cases. Stern, re- 
viewing 450 cases of epidemic encephalitis, 
encountered on’y one case of persistent 
epilepsy. Prof. Wimmer 11 of Copenhagen 
in 1927 reported 23 cases of encephalitis 
with epilepsy. It is interesting to note that 
Wimmer qualifies these convulsive seizures 
as “epilepsy in chronic epidemic encepha- 
litis,” feeling that they belong to the active, 
chronic, infectious process in the central 
nervous system, rather than to the symp- 
tom - complex of truly post - encephalitic 
residuals. Reviewing these case reports 
one is impressed with the variable length 
of time elapsing between the acute attack 
and the first typical epileptic seizure, the 
time ranging from one month as the earliest 


to seven and one-ha 1 f years as the latest 
time at which epilepsy developed after the j 
encephalitis. 

Two cases of epidemic encephalitis are 
reported, with residual epilepsy developing 
in the first case seven and one-half months 
after the initial acute symptoms and one 
and one-half months following onset of 
symptoms in the second case. 

Case R. C. B. White male, aged 3V2 years. 
The family history is irrelevant, the patient being 
the fifth pregnancy; both parents, two brothers 
and two sisters living and well. Whooping cough 
at four months of age, pneumonia at one year and 
measles at 18 months. Tonsils and adenoids re- 
moved at twenty-two months of age. At six weeks 
of age had continuous convulsions for one day. 
Seemed perfectly normal physically and mentally 
until onset of present symptoms. 

Forty-eight hours previous to first observation, 
July 22, 1928, patient had a convulsive seizure 
lasting about thirty minutes. With colonic flush- 
ing and alcohol sponging, patient relaxed and 
seemed inclined to sleep almost continuously. 
Temperature rose shortly after the convulsion; in 
the late afternoon of day of onset had a second con- 
vulsion of five minutes duration, following which 
he seemed unable to use the left arm and hand 
and lapsed into a state of complete somnolence 
from which the patient could be aroused, though 
immediately lapsed into a deep sleep. Vomited 
once at onset of symptoms. 

Physical examination showed a well-developed and 
well-nourished male child. Cranium of normal con- 
tour. Fontanels closed. Ears negative. Eyes have 
a stuporous stare, slight inequality of pupils, not 
constant, and hyperactive pupillary reflexes. Nares 
clear. Normal throat. No glandular adenopathy. 
Chest of normal contour. Lungs are clear. Heart 
negative. Abdomen scaphoid and doughy, minus 
two tissue turgor, spleen not palpable, liver pal- 
pable 2.5 c.m. Normal genitals. Left lower ex- 
tremity spastic with passive accentuation of spas- 
ticity. Brudzinski’s marked and Kernig’s well 
marked. Patellar reflexes exaggerated on right 
and retarded on left. 

Laboratory findings: Examination of blood on 

July 23, 1928, showed hemoglobin, 65; color index, 
66; erythrocytes, 4,800,000; leukocytes per cmm., 
12,200; small lymphocytes, 9; large mononuclears, 

3; neutrophiles, 88. 

Cerebro-spinal fluid: Amount, 15 c.c., color clear, 
water- white; erythrocytes, none; leucocytes, few; 
cell count, 15; globulin increased; sugar 15.3 
mgm. per 100 c.c. 


Naef — Post-Encephalitic Epilepsy 


127 


Progress : July 23, 1928. Spinal puncture pro- 

duced 25 c.c. of a clear, lipid fluid under increased 
pressure. Slight spasticity of left lower extremity. 
Persistent stupor and fixed glassy stare. Sleeps a 
great deal and does not evidence pain. Tempera- 
ture 103 3-5° rectal. 

July 24, 1928. No spasticity, though seems un- 
comfortable when lying in prone position. Marked 
lethargy continues, though in late afternoon, 
aroused and called mother. Brudzinski’s and Ker- 
nig’s signs positive. 

July 25, 1928. Seems much less lethargic. 
No spasticity, and spinal puncture produced only 
a few drops of blood-stained fluid under normal 
pressure. 

July 26, 1928. Bright and cheerful. Asks for 
food and parents. Brudzinski’s and Kernig’s almost 
entirely absent. 

August 4, 1928. Two weeks after initial symp- 
toms patient walked into office with the father, who 
detected a slight impairment in use of right leg 
and a tendency to unknowingly walk into objects. 
Physical examination at this time was negative 
except for a general sluggishness of motor activity, 
more marked in right extremity during walking, 
and slight impairment in speech. Patellar and 
other reflexes negative. 

August 15, 1928. Gait is more regular and 
animated, and patient has shown no tendency to 
walk into objects. No spasmodic contractions or 
flaccid paralysis. Complains of occipital headaches. 
Physical examination negative. Slight impairment 
of hearing in right ear. 

September 20, 1928. Weight 35 lbs., 10 oz., a 
gain of 2*4 lbs. over weight of six weeks previous. 
Has become restless at night and again seems to 
“run into objects unknowingly.” Complains of 
“ants biting him” over right eye and back of neck. 
Speech is more normal than at any time since onset. 
Examination of eye-grounds at this time reported 
negative. Entire physical examination negative. 
Hearing in right ear continues progressively 
defective. 

February 26, 1929. Appeared at office with the 
description of “fainting spells” during the two 
weeks previous. During these seizures, five or six 
daily, of only a few seconds duration, consciousness 
is lost, a fixed momentary stare develops, pupils 
dilate, face becomes flushed and slight contractures 
of muscles are present. Sleeps well and has no 
seizures in sleep. No fever. Always has a pre- 
monitory aura. 

April 30, 1929. Was admitted to hospital with 
temperature 103° following a severe convulsion of 
some five to ten minutes duration. On observation 
at this time was entirely relaxed, and free of con- 
vulsive twitchings, with no mental clouding, so no 
spinal puncture was indicated. 


May 13, 1929. Yesterday had a severe convul- 
sion of five minutes duration and presented the 
classical picture of an epileptic seizure, with biting 
of tongue and complete loss of consciousness. For 
past four days, has had twitchings of right hand 
and arm. Seizures are variable from 15 seconds to 
three minutes duration. 

From May 13, until July 19, no epileptic seizures 
occurred. On July 19th a seizure of five minutes 
duration was observed and again a similar attack 
on August 24. 

October 8, 1930, patient walked into office. From 
August, 1929, to February, 1930, had typical 
epileptic seizures at six to nine weeks intervals, and 
following these seizures for five or six days would 
have ten or twelve attacks resembling the so-called 
“absent state” of petit mal, when a fixed stare, 
momentary slight twitchings of facial muscles and 
fleeting loss of consciousness were present, with an 
occasional deep “crowing” inspiration at end of 
seizure. On February 22, 1930, had a most violent 
epileptic seizure since beginning of encephalitis, 
with loss of consciousness for nearly three hours 
(statement of mother). 

For one year from this date, remained entirely 
free from epileptic seizures of any type when a 
return of the attacks of the petit mal was noted, 
February, 1931. At this time had three seizures 
in one day. 

Ten days ago had three seizures within a half 
hour, these seizures presenting the classical picture 
of petit mal. 

Examination at present time shows a fairly well- 
developed male child of apparent age, somewhat 
sluggish mentally and physically, with no impair- 
ment of function and normal to all ^ neurological 
tests. Speech is heavy, with a tendency to lisping. 
Presents a complete character change with, habits 
of wandering from home, hyperemotionalism, and 
defective memory and concentration. Complete 
loss of function of right ear. 

Case H. J. A. Male child, aged 4 years. Mother 
living and well. Father has developed a sclerotic 
deafness and has entirely lost the function of one 
eye. Patient is the fifth pregnancy, the fourth 
pregnancy having miscarried. Three brothers and 
one sister living and well. No knowledge of tuber- 
culosis, cancer or lues. 

Full term, normal delivery, birth weight 7% lbs. 
Has had none of the contagious diseases. Had flu 
in January; prior to present illness had never had 
a convulsion; no intestinal disturbances; is a per- 
sistent bed-wetter and has night terrors. 

Forty-eight hours ago developed temperature 
101° associated with slight watery nasal discharge 
but no cough. Temperature persisted between 
100° and 101° and a marked change in disposition 


128 


Naef — Post-Encephal'tic Epilepsy 


developed, the patient alternating between periods 
of somnolence and excitability. Thirty-six hours 
after onset had a severe generalized convulsion of 
about five minutes duration. 

On evening of admission to hospital, Mar:h 3, 
1929, patient developed severe convulsive seizures 
lasting from five to seven minutes, recurring at in- 
tervals of from one to two hours; during the 
seizures, there is no biting of tongue but spasticity 
of all extremities follows, persisting for twenty 
or thirty minutes after each convulsion. 

Temperature ranges between 100° and 101° by 
axilla. Patient has seemed mentally confused and 
restless since admission to hospital. 

Examination shows a well-developed and well- 
nourished male child with temperature 100° by 
axilla. Confused mentally and generally restless, 
tossing arms and legs purposelessly. Normally 
shaped cranium. Normal ears, normal eyes, pupils 
equal and reacting. Normal nose, slight nasal 
discharge ; mucous membranes of lips of good color, 
tongue slightly coated, tonsils not enlarged or red- 
dened, pharynx reddened. No glandular enlarge- 
ments, a chest of normal contour, lungs clear 
throughout. Heart not enlarged, no murmurs. 
Abdomen retracted slightly, spleen palpable at 
costal margin, liver 3.5 cm.; no umbilical hernia; 
normal genitals. Normal back. Spine freely flex- 
ible; no cervical rigidity. Babinski’s and Brudzin- 
ski’s signs negative, with retardation of patellar 
reflexes. 20 ccs. of a clear limpid fluid obtained by 
lumbar puncture under greatly increased pressure. 

Laboratory findings, — March 5, 1929. Cerebro- 
spinal fluid. 20 c.c. clear water-white fluid. Ery- 
throcytes none; cell count 47, mostly lymphocytes, 
few leukocytes; globulin not increased; no bac- 
teria found in culture or smear. 

Blood examination on March 4, 1929, shows 
hemoglobin 60; color index 83; erythrocytes 3,- 
640,000; leukocytes per cmm 6,000; small lympho- 
cytes 32; large mononuclear 8; neutrophiles 58; 
eosinophiles 0; basophiles 2. 

March 5, 1929. Spinal rigidity not present. 
Brudzinski’s sign negative. Knee jerks retarded, 
mentality less clouded and motor activity more 
purposive. Occasional cough and moderate nasal 
discharge. 

March 6, 1929: Playing with toys. All reflexes 
negative. Seems much brighter. Nasal discharge 
more viscid. 

March 7, 1929: Was discharged from hospital 

much improved. 

March 16, 1929: Was brought to office when 
physical examination was entirely negative and all 
central nervous symptoms had disappeared. 

March 19, 192^- Recurrence of convulsions de- 
veloped and patient was readmitted to hospital. 


Convulsions are of same type as on previous ad- 
mission, occurring at intervals of one to two 
hours and lasting from two to four minutes each. 
Patient dazed and somewhat restless between con- 
vulsions, though took nourishment nad fluids read- 
ily. A lumbar puncture produced 10 cc’s of a 
clear fluid under slightly increased pressure and 
of a slightly pinkish tinge. 

Laboratory findings — Spinal fluid examination 
March 20, 1929. Amount 5 cc; color water-white; 
erythrocytes many; leukocytes few; lymphocytes 
few; cell count 792.5; tubercle bacilli not found 
and no organisms present; globulin not increased; 
Fehlings sugar trace. 

Elood and spinal fluid Wassermanns on H. J. A. 
negative; blood Wassermanns on mother and fa- 
ther negative. (March 21, 1929). 

March 20, 1929, Roentgen-ray examination of 
cranium shows an increased intracranial pressure. 
The irregularity of the outer table of the skull is 
rather suggestive of lues. 

March 21, 1929: No convulsions during twenty- 
four hours. 

March 22, 1929: Spent a good day having had 
no convulsions in past forty-eight hours. 

March 23, 1929: At 5:45 a. m. had a convulsion 
followed by four other convulsions during the 
night. Is mentally excited and violent, screaming 
loudly and tearing at nurse and bed clothes. Pro- 
fuse expectoration and drooling of saliva. 

March 24, 1929: Continuing very restless and 
violent, takes nourishment well but sleeps only 
under sedative medication. Spinal puncture at 
this time produced 5 cc. of a clear fluid under 
normal pressure. 

March 25, 1929: Continues very nervous and 
violent. Takes medicine and nourishment well. 
Eliminating well. Temperature normal since 2nd 
day in hospital. No convulsions and seems less 
violent, but still mentally clouded and restless. 
Takes long naps, and has had no convulsions since 
the night of March 23. 

March 26, 1929: Awoke this morning after a 
9-hour sleep and because of persistence in sitting 
up, was allowed in wheel-chair and seems less 
excited. Nourished well, temperature continues 
normal: No convulsions. 

March 27, 1929: Nervous condition much bet- 
ter today, had a 3-hour nap, took all medicines 
and nourishment well and seemed more lucid. 
Sleeps well at night. 

March 29, 1929: Resting well, no further con- 
vulsions. Nourishes and eliminates well. 

March 30, 1929: Condition same as on pre- 
vious day and on March 31 was discharged from 
hospital. 


Naef — Post-Encephalitic Epilepsy 


129 


From March 30, to April 9, patient seemed 
normal and rational, though had developed a gait 
resembling paralysis agitans, while speech con- 
tinued somewhat inarticulate. At this time a 
typical epileptic seizure developed and because of 
the remote possibility of lues, as suggested by the 
roentgen-ray report, antiluetic medication was 
administered. Because of aggravation of all 
symptoms following this plan of treatment, it was 
abandoned. Convulsions continued, 3 to 5 seizures 
daily, from April 10 to April 25, following which 
the patient’s gait became more nearly normal and 
seemed better in every respect. Since April 25 
epileptic seizures have recurred at intervals of 
2 to 4 weeks. Mentality is sluggish and a slight 
impairment in gait persists. 

August 2, 1929: Patient shows definite signs 
of mental deterioration with dull expression, fixed 
stare, and almost unintelligible muttering; drool- 
ing of saliva; complete lack of concentration and 
disorientation to time and pace. Marked insomnia, 
associated with a desire to be out of bed, alter- 
nating with periods of stupor, when he goes into 
a temper-rage if asked to leave the bed. Walks 
with the typical gait of paralysis agitans, and 
shows a coarse tremor of hands. Incontinence of 
urine and feces persists. Epileptic seizures con- 
tinue severe, and occur every two or three weeks. 

Following this last observation, patient became 
so violent and unmanageable, it became necessary 
to place him in an institution. 

Since beginning of institutional care the patient 
has been having typical epileptic seizures every 
three or four weeks, while mental deterioration 
has been slowly progressive. The parkinsonian 
gait and the coarse tremor of the hands have per- 
sisted. 

COMMENT. 

Both cases presented the mental and neu- 
romuscular phenomena usually seen in ence- 
phalitis ; the spinal fluid findings reinforced 
a first impression of epidemic encephalitis 
in the first case (R.C.B.), and established a 
diagnosis of encephalitis in the second case 
(H.J.A.), where the presence of a definite 
nasal discharge in conjunction with a red- 
dened pharynx and a history of repeated in- 
fluenzal infections caused a suspicion of in- 
fluenzal meningitis. The latter case was un- 
doubtedly influenzal in origin, though no 
signs of meningeal involvement ever pre- 
sented. 

Both cases confirm an earlier observation 
that encephalitis may recur in the same pa- 


tient with variable symptoms, thereby evi- 
dencing the later changes of the same path- 
ological involvement. The development of 
epilepsy as a residual appears as an end-re- 
sult of chronic, progressive subcortical in- 
volvement, with sclerotic changes extending 
to or including cortical areas either through 
direct extension, or by traction of develop- 
ing scar tissue on the cortex. Whether a 
post-encephalitic epilepsy is permanent is 
not known, because of limited observation 
through comparatively recent recognition of 
these cases. 

Administration of ketogenic diets exerted 
no inhibiting effect whatever on the epileptic 
seizures in either of these cases. 

Case R. C. B. is now a problem child and 
in spite of his year of complete absence from 
all symptoms will continue a potential epi- 
leptic of the milder type. Because of the 
rapid and extensive mental deterioration of 
case H. J. A., this patient will remain a per- 
manent institutional case. The prognosis in 
any case should always be guarded, and, 
while not serious as regards life is always 
a potential menance to perfect development 
of the central nervous system. 

REFERENCES. 

1. Hall, A. J. : Brit, W. J. 1:110-111, 1925. 

2. Gorter, E. : Several forms of curable meningitis and 

encephalitis Nederl. Tijdschr. and Geneesk 72:4489, 1928. 

3. Throckmorton, T. B. : Intermittent muscular spasms, 

resembling Jacksonian epilepsy complicating recurrent epi- 
demic encephalities. Jour. Iowa State Med. Soc. 20:11-15, 
1930. 

4. Price, G. T. : Epidemic encephalitis, recurrence of 

symptoms 1 % years after apparent recovery. J. A. M. A. 
78-716, 1922. 

5. Tilney and Howe : Epidemic Encephalitis, published 

by Paul Hoeber, N. Y., 1920. 

6. Halliday, Quart. Jour. Med. 18 :300, 1926. 

7. Beverly, Bert L. : Encephalitis in children, Amer. 

Jour. Dis. of Child 37:600-610, 1929. 

8. Kennedy, R. L. J. : Amer. Jour. Dis. Child. 28:158, 

1924. 

9. Anderson: Quart. Jour. Med. 16:173, 1923. 

10. Lemos, M. : Intermittent claudication. Rev. Neurol. 

40:425, 1924. 

11. Wimmer, A.: L’Epilepsie dans L’Encephalite Epi- 

demique Chronique. Rev. Neurolog. 2:269-76, 1927. 


CASE REPORTS AND CLINICAL SUGGESTIONS 


INACCURACY OF CLINICAL 
THERMOMETERS. 


OSCAR W. BETHEA, M. D., 

New Orleans. 

About two years ago I became impressed 
with the frequent inaccuracy of the clinical 
thermometers in common use, and in order 
to investigate the conditions that obtained 
in this particular field, I adopted the fol- 
lowing plan : 

I bought the best obtainable thermome- 
ters, several at a time, and sent them to the 
Bureau of Standards at Washington for 
standardization. I first tried the plan of 
placing two of these correct thermometers 
under the tongue of a patient, letting them 
remain for five minutes and comparing the 
readings. Repeated trials indicated the 
almost absolute correctness of the test if 
sufficient care was used in the procedure. 
I then began to test the thermometers in 
the homes of my patients, and while this 
was frequently inconvenient I have suc- 
ceeded in thus checking the family ther- 
mometers in one hundred and sixty-four 
homes. The manufacturer’s name could 
not always be determined, as many of the 
instruments only bore the name of the dis- 
tributor. But altogether there were forty- 
three different labels and most of the 
common makes were represented. The re- 
sults were as follows: 


Correct 
+0.2° F. 
+0.4° F. 
+0.5° F. 
+0.6° F. 
+0.8° F. 
+ 1.0° F. 


63 

40 

31 

5 

7 

2 

1 


+1.4° F. 
—0.2° F. 
—0.4° F. 
—0.8° F. 


1 
5 
7 
2 


It will be noted that about one-third of 
these are so inaccurate that the information 
obtained might be decidedly misleading. In 
one hospital where this investigation was | 
carried out, the thermometers were so 
uniformly inaccurate that the entire stock | 
was thrown away and new thermometers 
of a different make were purchased. Illus- 
trative of the conditions that have occasion- 
ally developed the following case will be of 
interest. A young lady attending a college 
in a distant city came to New Orleans for 
the Easter holidays. She complained of a 
slight headache, the family took her tem- 
perature and found that the thermometer 
indicated some fever. She was kept in bed 
throughout the entire Easter vacation as 
she still showed elevation of temperature. 
The family had not considered her sick 
enough to call in a physician, but I was 
summoned only when her return to school 
became a matter of importance. I found a 
perfectly well young lady and a thermome- 
ter that registered about +0.8° F. too high. 


The usual inaccuracy is in the form of 
an elevated reading. This is due to a ther- 
mometer being finished and put on the 
market while it is still “green.” A small 
amount of shrinkage later takes place and 
this has the tendency of forcing the mer- 
cury upward. 


For the last two years I have made it a 
rule to accept no temperature charts from 
patients without having them submit their 
thermometers for testing. 


REVIEWS 


NOGUCHI 

by 

GUSTAV ECKSTEIN.* 

A REVIEW 
by 

RUDOLPH MATAS, M. D., 

New Orleans. 

No one who is at all familiar with the 
events that have marked the progress of the 
medical sciences in the last three decades 
can fail to recognize in Hideyo Noguchi 
on outstanding figure in the great advance 
of the century. To those who, like the 
writer, have had the privilege of a personal 
contact and watched him at work in his 
laboratory at the Rockefeller Institute, of 
New York, it is likely that they will retain 
not only the impression, but the conviction, 
that Noguchi was, in his own field of re- 
search, one of the greatest of contemporary 
scientists, an artist who worked in the 
technic of science with consummate skill, 
with the artistic fervor of a great virtuoso 
and achieved with an artist’s vision. 

But no one, whether he be merely a reader 
interested in the human side of a great 
man’s life, or a physician chiefly concerned 
in the psychology and mechanism of scien- 
tific achievement, can read the story of the 
great Japanese master, as told by Gustav 
Eckstein, without being thrilled and elec- 
trified by the driving power of the nar- 
rative. 

The Story of Seisaku, later known as 
Hideyo Noguchi, is that of a child born, 
in 1876, of poor peasant farmers in the 
village of Okinajima, an obscure province 
of Japan. The father was an intemperate 
n’er-do-well, but the mother, — Shika, was 
a sturdy and devoted woman who had seem- 
ingly inherited the heroic qualities of some 
of her yeoman ancestors, vassals of the 


*Harper Brothers, New York, 1931, 8° Portrait 
and 13 illustrations, 419 pp. $5.00. 


Lord of Aizu, — which she apparently trans- 
mitted to her son. Unfortunately, the child 
when only beginning to crawl, fell into the 
family Urori, — an open brazier filled with 
live coals, which so terribly burned him 
that he barely escaped with his life and 
was left with a scarred hand which was 
little more than a stump. Despite this han- 
dicap, which made it look as if Seisaku 
would have no prosperity either as a “far- 
mer or as a hero,” he rose out of his pov- 
erty and other discouraging obstacles, to 
attract the attention and affection of his 
teachers. These, from his earliest school 
days, were struck by his precocity and 
extraordinary aptitude for acquiring know- 
ledge. 

At the primary schools the children 
jeered and taunted him for his deformity 
and ragged clothes. But he fights. “Seisaku 
does not come of Samurai, he comes of 
farmers; farmers settle things with their 
fists, even one fist.” And he rises and the 
boys soon learn that he is cleverer and 
stronger than they; and when it comes to 
science, drawing and English, he is as good 
as the teachers themselves. He becomes a 
Kyucho, chief of the class, and no one would 
now dare to be rude to him. 

Ever conscious of his affliction which 
keeps him aloof of all boyish companion- 
ship, he is taken by one of his teachers to 
Wanatabe San — a celebrated local surgeon 
of European and American training, in the 
distant town of Wakamatsu, who becomes 
interested in the boy and performs a plastic 
operation which releases the stumps of his 
burnt fingers out of the mass of scar. “The 
stumps now become movable. Each stands 
by itself, each moves alone, and the scars 
that glued the hand to the wrist are severed 
through. The hand hangs quite like any- 
one’s hand.” The operation works a miracle 
in the boy’s hand and in the boy’s mind. 
His youthful imagination is fired by the 
success of the operation and he resolves to 


132 


Reviews 


become a doctor. Yes, not only a doctor, 
but a Napoleon in his profession. “Not 
to fight battles, not to kill people, but to 
save them with a will of a Napoleon.” The 
surgeon keeps him as one of his “drug 
boys,” — a sort of apprentice, and with this 
he reaches a decisive point in his career. 

Among the Japanese doctors who prac- 
tice in the countryside, there persists many 
traditions of Chinese Medicine. Burning 
with the noxa is a remedy for many ills, 
more powerful than many modern doctors 
think, “even a cure for stubborness in boys,” 
and one of the doctors goes so far as to say 
that the burning of Seisaku’s hand, has put 
something into his blood and it is that 
which gave Seisaku strength to stay up so, 
‘night after night, eternally reading and 
learning from books.” For weeks, it is 
quite true, he has not so much as taken off 
his clothes. When late at night Wanatabe 
looks where the drug boys sleep, he always 
finds the youngest still awake. The boy 
“is Heaven and Earth for learning.” Drug 
boys are supposed to bring their own bed- 
ding, but Seisaku has none and he sleeps on 
straw as he did at his mother’s home on the 
farm at Okinajima. After all, “one sleeps 
but three or four hours a night and for 
that length it is possible to sleep soundly, 
even under the Master’s desk.” 

A curious episode occurs while he works 
with his master, Wanatabe. A patient 
comes with a strange, long continued, un- 
dulating fever. The doctor prepares a slide 
with some of the patient’s blood and to his 
surprise discovers among the corpuscles a 
minute spiral organism, — the spirocheta 
of relapsing fever! Wanatabe is excited 
by his discovery. He calls the drug boys and 
all five come running. They all see it. Sei- 
saku sees these strange little corkscrew- 
like bodies and he lingers long at the micro- 
scope. This is fate . . . His life was 
changed looking into that microscope and 
when he steps back from it, he says a few 
words that would strike anyone as queer. 
He says that he now knows not only that he 
will be a doctor, but the kind of doctor, — 


a bacteriologist. It is probable that one 
or the other of the drug boys laugh, but 
Wanatabe, the master, does not laugh, for 
Wanatabe remembers how, with the same 
suddenness, this little Seisaku a little while 
ago, made up his mind to Medicine as if he 
did not have to think, as if he knew directly 
what he ought to do. 

And when Wanatabe leaves for the war 
with China he puts Seisaku, the youngest 
and the latest comer, in charge of his dis- 
pensary. When the war is over and Wana- 
tabe returns, he is amazed at the meticu- 
lous care that Seisaku has given to his 
accounts and, what is more, at the extra- 
ordinary amount of knowledge that the boy 
has acquired and stored during his absence. 
After a few questions, he decides that Sei- 
saku is ready for the first examination at 
the Medical School at Tokyo. 

With the aid of his teachers and contri- 
butions from friends, and impelled by his 
own limitless ambitions and tireless indus- 
try, he graduated after many curious ex- 
periences, in the Medical School at Tokyo. 
There he came in contact with the great 
Japanese masters of bacteriological re- 
search, Kitasato, Shiga and other superior 
minds, who encouraged his natural bent to 
the study of microscopy and bacteriology 
and pathology. 

How he changes his name while a medi- 
cal student from Seisaku to Hideyo is in- 
teresting. One day he picked up a novel 
by a popular Japanese author, which was 
creating a good deal of popular discussion. 
“The Life of a Contemporary Student.” 
What is odd is that the hero has almost his 
own name, — Nonoguchi Seisaku. What is 
odder, is that the hero is also a medical 
student and, oddest of all, is, a student of 
the highest promise who, caught between 
women and drink, comes to a bad end. It 
is only a story, but Seisaku worries to think 
that he may go through life with a name 
tainted in a novel. After long meditations 
he decides to change his name from Seisaku 
to Hideyo. Hide , — the first name of one of 


Reviews 


133 


his teachers, (Kobayashi) meaning “great 
man,” and Yo — “the world;” which put to- 
gether, — “Hideyo,” — means a great man of 
the world. He consults his old teacher and 
mentor, Kobayashi-san who ultimately ap- 
proves, and henceforth the name Seisaku, 
d'sappears and Hideyo Noguchi remains 
for the rest of his days. 

In the meantime, through his own un- 
aided efforts he had acquired a working 
knowledge of English, German and French. 
After his graduation an opportunity pre- 
sented itself to accompany a Japanese gov- 
ernment commission to study Bubonic pest 
in China and he profitted by this experi- 
ence to improve his practical knowledge of 
medicine and to master the Chinese lan- 
guage, an acquisition which, when com- 
bined with his other linguistic abilities, 
gave him great advantages over his asso- 
ciates. In 1900, chance brought him in 
contact with Dr. Simon Flexner and Mr. 
Frederick Gay who stopped at Yokohama, 
where Noguchi was stationed as quaran- 
tine physician. His ambition had been, for 
years, to study and develop a scientific 
career in America, and this meeting served 
as the first link in the chain that bound 
him with the ties of a grateful affection 
to Dr. Flexner for the rest of his days. 

In 1900, when he had just attained his 
twenty-fifth birthday, with only a few yen 
and his brain as his capital, he crossed the 
ocean and landed in Philadelphia, where 
through the patronage and kindness of Dr. 
Flexner and Dr. S. Weir Mitchell, he was 
given employment as a volunteer assistant 
in the University of Pennsylvania. There 
he began to work under Dr. Mitchell’s di- 
rection, on the venom of snakes, especially 
the toxins and antitoxins of the American 
rattler, and soon attracted attention by the 
thoroughness and originality of his work. 
This earned him a Carnegie scholarship 
which he utilized with great profit for a 
year of study in the Serologic Institute of 
Copenhagen, under Professor Masden, 
later to be his life long friend. 


Thus began his American career which 
was to continue uninterruptedly in the 
ascendant for the remaining twenty-seven 
years of his life. At the Rockefeller In- 
stitute in New York he rapidly rose to 
celebrity as an original and prolific inves- 
tigator in bacteriology, serology and im- 
munology. Before he had attained the 
early maturity of his manhood he had 
reached the summit of scientific achieve- 
ment. He continued to rise and his fame 
was world-wide, with honors showered 
upon him by the learned societies of all 
countries. He had apparently reached the 
zenith of his career when he was stricken 
and died in his fifty-second year,- on May 21, 
1929, at Accra, British West Africa, a 
victim of Yellow Fever — a disease which 
he had relentlessly pursued and striven to 
conquer with all the science, the energy and 
the weapons at his command. 

This is brief, is the skeleton outline of 
the extraordinary life of the Japanese 
savant, which has served as the founda- 
tion for Gustav Eckstein’s intensely dra- 
matic biography — a biography, which he 
has invested with a compelling interest and 
fascination that is all absorbing and un- 
yielding, from the beginning to the end 
of the book. 

* * * 

The prospective reader must not expect 
to find here a scientific or technical treat- 
ise on Noguchi’s discoveries and methods, 
or even a bibliographic record of his work. 
To do justice to this phase of the subject 
it would require not another book, but a 
large space in a library to hold the Bulle- 
tins of the Carnegie Institute in Washing- 
ton and the whole series of volumes of the 
Journal of Experimental Medicine, the or- 
gan of the Rockefeller Institute, which, 
since 1902, was the chief repository of his 
publications. In this, are contained in- 
numerable monographs and papers which, 
from the date of the foundation, were of 
sufficient importance to command the atten- 
tion of his fellow scientists throughout the 
world. 


134 


Reviews 


Each of Noguchi’s scientific achieve- 
ments, and they were legion, beginning 
with his earlier work on the toxins and 
antitoxins of venemous snakes (1901-1904) 
and ending with his unfinished studies on 
the specific bacteria of trachoma, so la- 
boriously pursued in the Indian reserva- 
tions, of this country (1926-1928), and 
which were published after his death — 
would do honor to as many experts. These 
achievements are not overlooked, or is their 
scientific importance minimized by his all 
searching biographer, but the scientific side 
of the man is made far more interesting 
by the telling of how Noguchi worked in 
his creative moments — while elaborating 
his ideas and by the part that his discov- 
eries played in the drama of his life. Each 
one of his most important discoveries fur- 
nishes material for reflections, episodes and 
anecdotes, all of them very diverting and 
many of them quite amusing. In this way 
we follow the scientist and the man with 
all his human attributes, as he moves and 
thinks and works in his laboratory and in 
his home, where the work continues for 
the twenty-four hours without knowing 
when the night is ended and the day be- 
gun. He had been told in his childhood 
that Napoleon only needed three hours for 
sleep, but he decided that he could do even 
with less. Often when he was working 
on a specially important problem he would 
be seized with a frenzy for work and re- 
mained for days and nights in his labora- 
tory, appearing at home only for short 
intervals to reassure his wife. 

The discovery of the treponema pallida, 
by Schaudinn, the germ of syphilis, in 
1905, roused in him a passionate interest 
in this organism and in the whole spiro- 
chetal family, an interest which had been 
kindled in his boyhood when he had a view 
of a spirocheta, the spirillum of relapsing 
fever, in the microscope of Wanatabe, the 
surgeon of Wakamatsu, when working for 
him as a boy apprentice in his office. After 
1905, Noguchi soon became the leading au- 
thority on the spirochete and by differen- 


tiating the various species which are close- 
ly related morphologically to the treponema 
of syphilis, and discovered other species 
which contributed very materially to the 
differential diagnosis of the disease itself. 
He added to the usefulness of the Wasser- 
mann test by simplyfying it and by fur- 
ther developing (1910) his luetin skin re- 
action. He was the first to make pure cul- 
tures of the Treponema of syphilis and 
again, in this way, he simplified the 
identification of the parasite and made 
it easier to inoculate in pure cultures 
upon the experimental animals, the mon- 
key and the rabbit. Following this, came 
his discovery of the syphilitic nature of 
general paresis of the insane and of loco- 
motor ataxia (1911-1913) a discovery 
which not only revolutionized the etiolo- 
gical concept of these diseases, but their 
mode of treatment. Alongside of this 
work he experimented successfully with 
the virus of rabies, of vaccinia and of 
herpes, of infantile paralysis, and with the 
germ of Rocky Mountain spotted fever and 
added vastly to the knowledge of these 
diseases. Later, he traveled to Peru where 
he studied the Oroya fever of the Andes 
and the fearful Verruga disease of that 
country, and there determined, after 
months of patient and laborious experi- 
mentation, that these diseases were caused 
by one and the same organism which he 
identified for the first time, as the Bar- 
tonella baccilliformis. These and many 
more achievements which we need not 
mention, sufficiently attest his unparalleled 
industry and scientific productiveness. 

In 1917, he was profoundly prostrated 
by an attack of typhoid fever from which 
he barely escaped with his life. He was 
still an invalid when he was invited by 
General Gorgas to head a mixed American 
and Latin American Commission to inves- 
tigate the causes of Yellow Fever, where 
it was still prevailing endemically in Ecua- 
dor, Peru, Brazil and Mexico. By that time 
the truth of the mosquito theory of yellow 
fever transmission, so long upheld by Car- 


Reviews 


135 


los Finlay and triumphantly demonstrat- 
ed in Cuba (1901) by the epochal labors 
of Walter Reed, Carroll, Lazear and Agra- 
monte of the United States Army Board, 
had already asserted its supremacy over 
yellow fever wherever the mosquito could 
be excluded, eradicated or controlled. Un- 
der the leadership of Gorgas, or by adopt- 
ing his methods, it had been stamped out 
in Cuba, the Panama Canal, Louisiana and 
the Southern United States, the ports of 
Mexico, Brazil and other countries in which 
the same anti-mosquito principles had been 
applied. But it was plainer every day, 
that with increasing travel and with re- 
laxing vigilance old foci would flare up 
after they were believed extinct. In 1918, 
the prevention and control of yellow fever 
epidemics was no longer a theory but a 
fact wherever mosquito eradication could 
be efficiently carried out. But the discov- 
ery of its essential cause with a view to 
its prevention in the exposed individual, 
and its cure after it had developed, was 
the problem facing Noguchi when he was 
summoned to Ecuador and Peru to further 
investigate the disease from this view 
point. He lost no time in preparing for 
the expedition under the auspices of the 
Rockefeller Health Board, and was on the 
field at Guayaquil, in 1918. Gorgas be- 
lieved that when the cause of Yellow Fever 
would be found it would prove to be an 
organism very like the germ of infectious 
jaundice (Weil’s disease), and Schaudinn, 
the discoverer of the spirocheta of syphilis, 
predicted that a spirocheta would one day 
prove to be the cause of yellow fever. No- 
guchi’s long and exhaustive study of the 
spirochetae, in connection with his study 
of the treponema of syphilis, had prepared 
him specially well for this task. He had 
already introduced the name Leptospira 
( lepto , slender, syira, spiral), to designate 
the specific spirocheta of Weil’s disease 
which he had previously investigated and 
differentiated in many human and rat 
strains. In Guayaquil, he was soon able 
to isolate and cultivate a leptospira from 


the blood and organs of yellow fever pa- 
tients which was morphologically identical 
with that of Weil’s infectious jaundice. 
After a prolonged series of experiments 
he was convinced that this organism was 
different from that of Weil’s disease and 
that it was specific for yellow fever. He 
therefore named it the leptospira icteroides 
to distinguish it from the leptospira ictero- 
hemorrhagica. He also believed that mos- 
quitos were infected by this germ and that 
they could transmit yellow fever to the 
guinea pig, as we then thought, a suscep- 
tible animal. Apparently the same or- 
ganism was found in many of the yellow 
fever cases in Peru, Mexico, and later, in 
Bahia, Brazil. A vaccine prepared with 
Noguchi’s Leptospira appears to have had 
some prophylactic effect on a body of non- 
immunized Ecuadorian troops. 

The majority of the doctors who were 
associated with Noguchi agreed that he had 
found the specific cause of the disease and 
he was accorded a perfect triumph by the 
government and people in Ecuador on the 
eve of his departure from Guayaquil. But 
there were others, even some of his asso- 
ciates who were not willing to accept his 
discovery as a reality, and objections came 
especially from Cuba, Brazil, Mexico and 
the European possession in West Africa. 
He was beginning to feel the weight of 
these objections when news came from the 
Rockefeller Yellow Fever Commission in 
West Africa, that monkeys and not 
guinea pigs, were susceptible to yellow 
fever by direct inoculation even by 
direct inoculation even by mere epider- 
mal friction as well as by a mosquito 
inoculation from human subjects, a hith- 
erto unknown fact. But what was more 
disconcerting was that in the human 
subject as well as in the monkeys, 
Noguchi’s leptospira, or a leptospira which 
presented the specific characters that 
he attributed to it — was absent! He then 
abandoned his work in New York and 
started for Accra in West Africa on what 


136 


Reviews 


was to be the last of his argonautic expe- 
ditions in quest of his deadly tropical foe. 
* * * 

“The gods (of Medicine) are frankly 
human, sharing in the weaknesses of 
mankind, yet not untouched with a halo 
of divine Romance (Blakeney). 

Throughout the book, the author lets 
Noguchi speak for himself, and it is amaz- 
ing to what extent Eckstein has been 
able to convey to us the impression of his 
living personality. To do this he collected 
Noguchi’s earliest correspondence with his 
Japanese teachers, friends and others be- 
fore and after his advent to America. It 
is evident from this that Noguchi’s letters 
must have been treasured by those who 
received them. Whenever these are lack- 
ing, Eckstein reproduces many of Nogu- 
chi’s diary-like notes which appear to have 
been interspersed among many of his pa- 
pers. In these, Noguchi gives free vent 
to his own thoughts and reflections upon 
all the subjects that at the time interested 
him. In addition, the author seems to have 
saturated himself so thoroughly with the 
early environment of his hero in Japan, 
and made himself so conversant with Ja- 
panese customs, traditions, mode of thought 
and expression, that at times one wonders 
how a foreign writer could have so thor- 
oughly immersed himself in the Japanese 
atmosphere and yet preserve his occidental 
identity. The author has put an immense 
amount of labor in consulting and record- 
ing the observations and conversations of 
Noguchi with his intimate friends and 
others, who lived in close touch with him 
in his batchelor days and in his married 
life, but Eckstein’s literary craftsmanship 
is too fine, too fluent, to allow this hard 
work to become apparent. 

Some of the most interesting and de- 
lightful passages in the book are those 
which record Noguchi’s habits, his moods 
and humors, his absentmindedness, his im- 
providence in regard to money matters and 
his eccentricities which were revealed in 
the intimate circle of his domestic life. 


Perhaps these were best told by his de- 
voted wife, an American, Miss Mary Rud- 
dis, whom he married in 1911, in his thir- 
ty-fifth year, and to whom he always lov- 
ingly refers to as “Maizie.” 

Here are a few samples : Before his mar- 
riage he occupied an apartment with a 
Japanese room-mate, Araki. Between the 
two they do the cooking. Sometimes it is 
necessary to watch the boiling rice. Araki 
does not like to, but Noguchi is always will- 
ing, brings his chair into the kitchen, puts 
the chair up to the gas range and props up 
his feet and continues to read. Suddenly he 
turns to Araki, “What is the smell?” He 
seems never to grasp that the smell could 
come from the boiling rice that he is 
watching. Araki snatches the cover of the 
boiler. Noguchi looks in. He shakes his 
head. “Yes, it’s gone, we go out to eat.” 

“He goes to the restaurant. The waiters 
know his way and begin to serve him, 
never asking Noguchi what he wants, be- 
cause Noguchi always wants the same 
thing. Noguchi does not say a word, not 
even in the beginning for politeness. Right 
away opens his book, puts it next to his 
plate and no one disturbs him. Yet Araki 
cannot help noticing how Noguchi eats, 
because that’s peculiar. He pokes his fork 
toward his plate, has no idea what he is 
poking at, but whatever it is at the end of 
the fork, he puts in his mouth; and when 
he is using chop sticks, it is remarkable — 
to carry rice from a bowl you don’t see.” 

After he married, he soon transformed 
his kitchen and dining table into a labora- 
tory. To begin with, “Maizie” has always 
to be pushing the microscope and papers 
off one end of the table so as to be able 
to lay the cloth half way. Before the meal 
is over he is stepping around to the micro- 
scope, sharpens a pencil and spreads his 
yellow note paper around and lights a 
cigar. Presently Maizie has the table 
cleared, the dishes washed and is back in 
the dining room. She would rather “Hidey” 
were at his microscope than writing. If 


Reviews 


137 


he is writing when she talks, suddenly he 
will thrown down his pencil “I can’t write.” 
Then she has to be still. But if he is at 
the microscope, she reads and he listens 
and it is astonishing how well he remembers 
everything that happens in those old tales.” 

“Plain that there is little leisure in this 
married life. ‘Hidey’ is always at that 
Institute. How he loves that place, and he 
has not enough with working there, but 
must bring it home with him and is filling 
the kitchen with it. That kitchen is a sight. 
He takes pictures of germs and develops 
the pictures and slops water over every- 
thing. Maizie complains. He answers that 
she must come and" see. ‘Oh ! it is lovely, 
Maizie, it is lovely.’ ” 

At the Institute he is a different person ; 
there his individuality is all submerged in 
his work. He does not indulge in any fan- 
cies or laxities of action or speech. There 
he is all in his technics, there he is a “flat 
wall.” As one there, who sees him well, 
says, “a flat oriental wall.” 

The following incident is perhaps as 
typical of Noguchi’s home life while work- 
ing on an important problem, as any in 
the book. 

At the time when he was searching for 
the spirocheta pallida in the brain of in- 
sane paretics, a characteristic incident oc- 
curs. He arrives, after a hard day’s work, 
from the Institute with a batch of 200 
slides which he has stained and prepared 
for inspection at home that night. He is 
tired with the grind of weeks of continu- 
ous work and feels the need of diversion. 
After supper he plays chess, his favorite 
recreation, with his neighbor, Hori, until 
past midnight. The game exhilerates him 
and he feels invigorated. His wife has 
long since retired and calls him to bed. 
The night is cool and refreshing and he 
is wide awake. The silence is conducive 
to the best work. It is now past one o’clock 
and he decides to look at his slides. He has 
been examining a batch of 200 freshly 
stained slides every night for the past 


week, but has not yet been able to find the 
spirochete, which he is confident, neverthe- 
less, is there. He has examined the first 
hundred slides, has entered on the second 
hundred, presently he has examined the 
one hundred and fiftieth, the hundred and 
ninety-ninth: Nothing! Then he examines 
the two hundredth — the last for the night. 
He looks it over carefully like the others; 
back and forth, back and forth — ah! they 
are there, and in the two hundredth slide! 
Who would believe it! They are there in 
numbers. He calls, “Mazie, I think I’ve 
got them.” He lights a cigar, he is terribly 
excited. He looks again. “Yes, I’ve got 
them!” There is no possibility of mistake. 
He had been looking for the spirochetes as 
minute rolled up bodies, but there they are, 
really full sized spirochetes, and he has 
missed them in the other slides because 
their thread-like bodies were intimately 
blended and camouflaged among the brain 
dendrites. In the week that followed, it 
was fully established that the spirochete 
of syphilis was firmly entrenched in the 
brain of insane paralytics, and that gen- 
eral paresis was in reality a syphilitic dis- 
ease. A wonderful, reverberating fact ! 

Several stories are told of his reckless 
improvidence. Noguchi had no more idea 
of thrift or the value of money than a 
child. He showed this very early in his 
career, when he spent the 300 yen that his 
friend Chinaki had given him, with much 
personal sacrifice, to pay his passage to 
America. Every bit of this was spent on 
a great farewell party given to his friends 
the very night before sailing! Thanks to 
the same indulgent friend, his passage was 
paid; but this time, on the steerage. On 
arrival in San Francisco, he writes to this 
friend: “At my departure you showed me 
kindness, like sea and mountain, and I say 
thanks ten thousand times. I wait every 
inch and moment to hear from you . . . 
please remember me to all who have eaten 
out of the same kettle. With bent neck.” 
(signed) . 


138 


Reviews 


In regard to his thoughtlessness about 
money matters, Dr. Kligler who was asso- 
ciated with him in the yellow fever expedi- 
tions to Peru and Ecuador, writes that “he 
had assumed the impossible task of keeping 
Noguchi’s accounts straight for him. They 
never balanced. He never could say at the 
end of the day what he did with the money 
he received in the morning. He just put it 
into his pocket and handed it out again. I 
am not sure that on several occasions he did 
not hand out five dollar bills instead of 
ones. At the end I gave up trying. I gave 
him small sums, paid for him when I was 
about and let it go at that.” 

Here is a quotation that shows that 
whatever his other weaknesses, his little 
vanities, he did not allow flattery to cloud 
his clear judgment about himself. Some- 
one in Japan had written his biography in 
very eulogistic terms. “It is a bad book. 
No man is perfect like that book, and no 
man would want to be perfect like that 
book. That is not a human being. Life 
does not go on in a straight line like that. 
It goes up and down. It is only in the 
story that it does not go up and down.” 

And so we go on to the end of the book, 
reading page after page with increasing 
fascination until we come to the end and 
we feel that we have not only read the 
book, but Noguchi himself. We seem to 
have lived with him, we have heard him 
talk and think. We are familiar with his 
habits, his frailties, his mercurial tempera- 
ment, his soaring and ever unsatisfied 
ambitions, his joys and his sorrows and 
his extreme sensitiveness to all sorts of 
impressions and suggestions that affect his 
personality. 

Throughout all this extraordinary por- 
traiture, we recognize the exotic, psychic 
and physical orientalism that is inseparable 
from Noguchi’s individuality. He is a bun- 
dle of contradictions. On the one hand, 
primitive, emotional, self-indulgent and as 
wayward as a child, in his purely human 
relations. On the other, tremendously dis- 


ciplined, self - restrained and completely 
oblivious to the demands of the flesh, when 
he is at work — sublimated in his laboratory 
in the pursuit of his task. 

When one of his Japanese friends in 
referring to him mentions the word 
“genius” he loses his temper. “What! It 
is hard work that is genius. To work three, 
four, five times harder than anyone else — 
that is genius.” 

And who can doubt after reading this 
prodigious recital of his dynamic life that 
Noguchi was the incarnation of the Master 
Word— Work! 

Ah, yes ! “The colossal energy which 
gave him the ability to work for weeks with- 
out sleep when the fire of accomplishment 
burned in his brain. A tremendous passion 
for research combined with an infinite 
patience and persistence in the accomplish- 
ment of his ends,” and, what is more, the 
capacity to devise means for the attainment 
of his purpose that were not common to 
other men. That is genius ! 

❖ * * 

“O think not of his errors now; remember 
His greatness, ... all the noble exploits of his life, 
And let them, like an Angel’s arm unseen, 

Arrest the lifted sword.” 

(Coleridge: Death of Wallenstein.) 

To the veterans of the profession and to 
the people of New Orleans and the South 
who can still vividly recall the terrors of 
yellow fever and the perennial anxiety in 
which they lived until 1905, when the great 
sanitary victory won in the summer of that 
eventful year, relieved them of that fright- 
ful bondage — the tragedy of Noguchi’s 
death appeals with special pathos and 
significance. The sad part of the story lies 
in the fact that Noguchi believed with abso- 
lute conviction that he had unravelled the 
mystery that surrounds the cause of yellow 
fever and that the scientific world, trusting 
largely to his proven genius, had shared this 
belief with him. But as in so many in- 
stances, which so deplorably abound in the 
mournful epic of this disease, the exulting 


Reviews 


139 


victory of today is but the prelude of the 
defeat and despair of tomorrow, and so it 
was with Noguchi and the leptospira which 
he believed secreted the toxins of yellow 
fever. These he thought he had trained and 
tamed like the venomous snakes which he 
had handled so fearlessly in earlier 
years — and made yield their poison to make 
the protective antidote against their own 
bite. But he, like his favorite hero, Napo- 
leon, whose life had been one long paean of 
victory — now had to face his Waterloo. 
The evidence which had been steadily ac- 
cumulating in the course of the years that 
followed the glamorous triumph at Guay- 
aquil, was coming from all sides to disprove 
the protective value of his vaccines and 
antitoxins, and even the existence of his 
specific leptospira was denied. 

That he, the master mind and peerless 
investigator should have been deceived and 
his discovery of the leptospira icteroides, 
as the specific germ of yellow fever, should 
prove to be only the ghost of a great hope, 
was a thought that terribly depressed and 
humiliated him. Was his leptospira des- 
tined to follow in the funereal train of the 
microccocus xanthogenicus of Freire, the 
Peronospora lutea of Carmona, the specific 
enteric bacillus of Gibier, the microccocus 
tretagenus of Finlay, the bacillus icteroides 
of Sanerelli, and of so many other great de- 
lusions that dolefully testify to the fallacy 
of the scientific imagination and that now 
remain in history only as the dead ashes of 
long extinguished camp fires! — that was 
the question which was, no doubt, more 
than galling to this supersensitive man. 

But what no doubt affected him more 
deeply was the unswerving loyalty of the 
great philanthropic foundation which re- 
garded him as one of its foremost expo- 
nents, and legitimately prided itself in his 
great achievements. The Rockefeller Insti- 
tute held fast to its faith in his genius, and, 
despite the great sum of money that had 
been spent fruitlessly to distribute his vac- 


cines and serums all over the world, — never 
deserted him. 

Though depressed, ill (he had a cardiac 
lesions and was a confirmed diabetic) and 
careworn, — he was not defeated. Spurred by 
intolerable doubts and by the supreme de- 
sire to vindicate himself in the eyes of the 
scientific world, he braced himself to meet 
the storm of antagonism that was gather- 
ing about him, and decided — despite the 
appeals and remonstrances of his wife 
and friends — to embark at once for Africa, 
fully determined to pluck victory out of 
seeming defeat. He left New York for 
Accra (Gold Coast, British West Africa) , on 
October 27, 1927. Arrived at Accra, he sur- 
veyed the field which furnished the clinical 
material and a large menagerie of Rhesus 
and other monkeys which had been lavishly 
provided for his experimental researches. 
There he pursued his quest with the same 
indomitable will and sleepless energy that 
characterized all his scientific undertakings. 
Sometime after he had settled in his Afri- 
can laboratory, he wrote to his friends in 
America: “My work is so revolutionary, 

that it is going to upset all our old ideas 
of yellow fever.” He thought he had some- 
thing new. Another organism — which was 
fatal to the animals in which it was in- 
jected — black vomit in their stomachs and 
great destruction of kidney and liver.” But 
he was cautious, non-communicative, keep- 
ing his counsel to himself. Even Alex- 
ander Young, the able chief of the British 
station for yellow fever research a,t Accra, 
who was devoted to him, did not know what 
was in Noguchi’s mind. It is evident that 
Noguchi had lost all hope in his spirocheta. 
He was so convinced that African yellow 
fever was not the disease that he had dealt 
with in South America, that he appeared to 
have scarcely looked for it. “Whether the 
South American disease is also not Weil’s 
infectious jaundice, but a third disease, who 
can tell ? He soliloquized : ‘Not likely that 
he went altogether wrong, yet he may, and 
if he did, and he finds the right now, what’s 


140 


Reviews 


the difference. But suppose he does not 
find the right now?’ “Sometimes in the 
dawn, after a whole night spent in feverish 
poring over his microscope and his cultures, 
he looks gray and sick, and in the snap shots 
taken of him by enterprising visitors, he 
makes no effort to hide his crippled hand. 
Lets it lie there staring. It proves how 
tired or how indifferent, or possibly even 
how done, how through with the last 
vanities.” Once he is speaking passion- 
ately and ends: “This is the sunset for 

Noguchi and perhaps a bad one.” There is 
sadness about the last days in Accra. An 
all pervading gloom seems to saturate the 
place. Adrian Stokes, (1) the brilliant Irish 
pathologist, had died while working on 
yel’ow fever, in his laboratory at Lagos, a 
few months before Noguchi’s arrival. There 
are many things that forebode evil. Death 
stalked about the place. Still Noguchi 
works, works with his slides, his cultures, 
his monkeys and his little squad of impro- 
vised African assistants. “Where he gets 
that energy is harder and harder to see. It 
is always daylight now when he leaves his 
laboratory. Sometimes he burns through 
the whole night every light in the place, 
makes everyone wonder, makes this or that 
one think, how strange. Remarkable that, 
even in the midst of this intense and al’- 
consuming task, Noguchi should be thinking 
of other problems. His unfinished work on 
trachoma made him think of a trip to 
Egypt to gather more material for his 
studies before returning home. Finally, he 
began to say in letters that he believed he 

(l)Dr. Adrian Stokes, at one time professor of 
Pathology at Guy’s Hospital, London, was ap- 
pointed chief of the Rockefeller commission to 
West Africa and died of yellow fever at Lagos on 
September 19, 1927, age 41 years. He, and his 
associates Bauer and Hudson, discovered the trans- 
misability of yellow fever to monkeys and it is 
probable that he contracted the infection in his 
experimental work. 


has discovered the cause of the yellow fever 
of Africa, “but what he sees must be 
guardedly interpreted, this time he must 
not be wrong. But what’s left to do, right 
or wrong, can be done under the more de- 
liberate conditions of his own laboratory in 
New York.” There is no absolute reason 
for prolonging his stay in Africa and he 
decides to return to New York and sets the 
third week in May (1928) for his sailing. 
Whether he had discovered a path or struck 
a new light that would dispel the prevailing 
darkness, no one can tell. For his secret, 
if any, died with him. 

Noguchi, who had been immune to the 
yellow fever of South America, was now 
stricken with the yellow fever of Africa; he 
knew his disease and realized its gravity. 
“If he is convinced that he has found the 
cause of yellow fever, what he knows of that 
cause is locked essentia’ ly in his own head. 
There are notes, sealed tubes, and Young (2) 
has followed step for step, but the power to 
push through to the meaning is perhaps 
buried in himself. If, on the contrary, he 
is not convirced it might be easier to die 
than go back and face his friends.” “It is 
the end and I want to die.” Quotes his 
biographer. He died on the tenth day of 
his illness, on May 21, the time set for his 
departure for America. He was buried at 
sea and the waves that roll over the shores 
of the Dark Continent yield their secret no 
more willingly than the immutable Sphinx 
which is still there, on that African coast, 
grimly challenging with its riddle the best 
will and intelligence of civilized man. 


< 2 > Dr. William Alexander Young, head of the 
British Medical Research Institute at Accra, con- 
tracted yellow fever and died in the prime of life, 
age 39 years, a few days after Noguchi’s remains 
had been buried at sea. It was reported that 
Young incurred the fatal infection when making 
a post-mortem examination of Noguchi (Lancet, 
June 16, 1928). 


Editorials 


141 


NEW ORLEANS 

Medical and Surgical Journal 

Established 18UU 

Published by the Louisiana State Medical Society 
under the jurisdiction of the following named 
Journal Committee: 

S. C. Barrow, M. D., Ex-Officio 
For one year: W. H. Seemann, M. D., 

Randolph Lyons, M. D., Secretary 
For two years: John A. Lanford, M. D. 

For three years: S. M. Blackshear, M. D., 

H. W. Kostmayer, M. D., Chairman. 


EDITORIAL STAFF 


John H. Musser, M. D Editor-in-Chief 

Leon S. Lippincott, M. D M? Editor 

Willard R. Wirth, M. D Editor 

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Frank L. Loria, M. D Associate Editor 

D. W. Jones, M. D Associate Editor 

Jacob S. Ullman, M. D Associate Editor 


COLLABORATORS— COUNCILORS 


For Louisiana 
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J. H. Landrum, M. D. 


For Mississippi 
J. W. Lucas, M. D. 

L. L. Minor, M. D. 

M. W. Robertson, M. D. 
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1430 Tulane Avenue 

SUBSCRIPTION TERMS: $3.00 per year in 
advance, postage paid, for the United States; $3.50 
per year for all foreign countries belonging to the 
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News material for publication should be received 
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in duplicate when returning galley proof. 

The Journal does not hold itself responsible 
for statements made by any contributor. 

Manuscripts should be addressed to the Editor, 
14.30 'Tulane Avenue, New Orleans, La. 


THE CORONARY ARTERY IN HEALTH 
AND DISEASE. 

Under this caption Herrick,* whose repu- 
tation as an internist is wide-spread 
throughout this country, but whose spe- 
cial claim to fame rests upon his accurate 
original description of coronary occlusion, 
a condition which is now so generally recog- 
nized everywhere as one of the most im- 
portant causes of sudden death, discusses 
in a part of his presentation the mechanism 
of production of heart pain. It is pointed 

*Herrick, James B., Am. Heart Jour., 6:58^, 
1931. 


out that there are two main theories ad- 
vanced as to the causation of the anginal 
syndrome. The one ably supported by such 
outstanding men as Allbutt and Wencke- 
bach, as well as Vaquez, holds the pain is 
due to a stretching of the diseased wall of 
the aorta. The older theory contends that 
pain is due to spasm or disease of the coro- 
nary artery or to perversion of function of 
the muscle supplied by that artery. This 
theory is the older of the two, but after All- 
butt’s pronunciations was largely discarded. 
Now the pendulum is swinging the other 
way, and an increasing - number of physi- 
cians are becoming adherents of the coro- 
nary artery theory. In substantiation of 
this statement, Herrick details some twelve 
arguments which certainly would suggest 
to the clinical observer at least that heart 
pain is due to coronary dysfunction. Most 
of these arguments are old ones, as for ex- 
ample, the fact that nitrites dilate the coro- 
nary and relieve pain ; that angina is rare 
in syphilis, although aortic disease is ex- 
tremely common ; that angina is infrequent- 
ly found in auricular fibrillation; that an- 
gina is rare in “chronic myocarditis” ; and 
that adrenalin causes anginal attacks in old 
people but not in younger individuals in 
whom there is no presumable coronary 
lesion. Some of the more advanced theories 
that would substantiate the coronary idea 
include the fact that the hypoglycemia of 
insulin causes anginal pain due to low sugar 
content of the arterial blood ; moreover, 
anemia may produce anginal pain as a re- 
sult of insufficient oxygen to the heart 
muscles when under stress ; anginal pain 
may occur in hyperthyroidism ; the heart 
muscles again being poorly supplied with 
blood through the damaged artery, when 
an increased amount of blood is necessary 
on account of a heightened metabolism ; 
electrocardiographic evidence is very much 
more suggestive of a muscular degeneration 
as a result of coronary disease than to dis- 
ease of the aorta; and certain vasomotor 
phenomena as Raynaud’s disease are asso- 
ciated in a suggestive way with angina. 


142 


Editorials 


Herrick very justly states that the ulti- 
mate decision as to the causation of an- 
ginal pain has not been reached, and that 
only through the cooperation of the path- 
ologist and practitioner of medicine, the 
experimental physiologist and the student 
of electro-cardiography will the enigma be 
solved. 


A COMBINED MEETING. 

The suggestion has been received from 
various sources that the Annual Meeting 
of the Louisiana State Medical Society 
should be held at the same time as the meet- 
ing of the American Medical Association, 
when this latter organization meets the first 
or second week in May in New Orleans. 
This idea has been advanced by men not 
only in the City of New Orleans, but by 
physicians elsewhere in the State, who 
maintain and contend that it might be im- 
possible to hold a satisfactory State Meet- 
ing immediately proceeding the National 
Meeting. Their contention is that the one 
would detract from the other. The two 
meetings come together within a very few 
weeks of each other ; at best not more than 
three weeks will separate the two. On ac- 
count of the present economic depression, 
it is rather an imposition on a man to ask 
him to give up his practice at two distinct 
periods of time close together, and to be 
obliged to defray the necessary expense in- 
cident to travel and to sojourn in a strange 
city. 

Not only the New Orleans doctors but 
those of the State should be anxious to do 
all that they can to make the meeting of 
the American Medical Association an out- 
standing one. If our forces are divided it 
may well make both meetings unsatisfac- 
tory from the point of view of attendance 
by our State physicians. 

Antagonists of this suggestion hold that 
Lake Charles physicians have already ex- 
tended a cordial invitation to meet in their 
lovely city, and that this invitation having 


been accepted by the State Association it 
is in honor bound to go there. Everyone 
knows that Lake Charles will extend a great 
deal of energy and time making this meet- 
ing a success. It is bound to be so from 
the standpoint of the entertainment that 
will be provided and for the hospitality 
that will be extended, but will the Lake 
Charles doctors want a meeting without the 
usual attendance ? It is also contended that 
if a regular scientific program is not pre- 
sented that the state organization will lose 
its entity. This argument may be met with 
the statement that the House of Delegates 
of the State Society could meet the day be- 
fore the meeting of the American Medical 
Association, transact their business, and 
then adjourn to atend the scientific sessions 
of the American Medical Association. The 
non-office holding physicians of the State 
will be able to select subjects that will in- 
terest them from the variegated program 
of the American Medical Association, and 
can attend the scientific sessions just as if 
they were the scientific sessions of the Lou- 
isiana State Medical Society. 

The Louisiana State Medical Society has 
not been asked to meet next year in New 
Orleans. If there was a wide spread senti- 
ment for such a meeting, we feel quite con- 
fident that such an invitation would be 
extended. Physicians of Lake Charles have 
been so cordial in their invitation, that in 
return the only equitable, just, fair ar- 
rangement would be for the State Society 
to hold its meeting in this community in 
1933. 

There seems to be so much sentiment in 
favor of this suggested course of holding 
the two meetings concurrently, that it is 
suggested that the various District and 
Parish Societies discuss among themselves 
the plan. If there is a brisk sentiment in 
favor of holding the State Meeting at the 
same time as the National, it probably could 
be arranged. If there is no such general 
sentiment in favor of this proposition, it 
need not be entertained any further. 


Hospital Staff Transactions 


143 


HIDEYO NOGUCHI. 

The lives of all men who have attained 
great eminence in any line of endeavor 
possess a human interest which attaches as 
much to their personalities as to their mode 
of achievement. In dealing with the great 
men of Medicine, this human interest is 
legitimately increased by our professional 
curiosity to know more of their personal 
characteristics, their habits and their 
methods in the attainment of their desired 
ends. From this point of view the life of 
Hideyo Noguchi, the great Japanese savant, 
which has been so vividly portrayed by Dr. 
Eckstein,* and which is at present so justly 
attracting the attention of the reading 


*In response to the possible query as to who 
this Dr. Eckstein is, we quote the information 
which Dr. Eckstein furnished his publishers when 
asked for an autobiographical sketch. 

“Born, practiced dentistry, studied medicine, 
taught physiology, learned not much, read two or 
three men, learned a little, came to know two or 
three women, learned a good deal, made friends 
with two rats, learned prodigiously, wrote about 
the rats, continued to write.” 


public, is a fine example of a form of bio- 
graphic literature which appeals with spe- 
cial interest to the medical profesion. 

But quite apart from Noguchi’s vast 
scientific achievements and the romantic 
background in which they are set in this 
extraordinary biography, the tragedy of 
Noguchi’s death appeals to us as Southern 
doctors with special sympathy as an episode 
in the baleful history of yellow fever, a 
disease which is inseparable from the most 
poignant and unforgetable experiences of 
the people of Louisiana and of the South. 

For these reasons the Journal has de- 
viated from its established rules in regard 
to the limited space accorded to book re- 
views, by publishing Dr. Matas’ compre- 
hensive summary and sympathetic review 
of Dr. Eckstein’s vividly dramatic bio- 
graphy of Noguchi, in the confident belief 
that his contribution will be welcomed by 
our readers as a timely and recreative vari- 
ation from the more technical literature of 
this publication. 


HOSPITAL STAFF TRANSACTIONS 


VICKSBURG SANITARIUM AND CRAWFORD 
STREET HOSPITAL, STAFF MEETING. 

July 10, 1931. 

Abstract: Microcephalus — Dr. G. C. Jarratt. 

Patient — Freddie S., colored, male, aged 4 years. 

Chief Complaint: Does not talk, walk, or sit 

alone. Very greedy. 

Present Illness : Mother states that child seemed 
normal in every respect up until he was three 
months of age, at which time he began to have 
generalized convulsive seizures that lasted from 
two to twenty minutes and would have as many 
as eight to ten seizures in 24 hours. This con- 
tinued until child was about one year of age; 
there have been none since then. Child has never 
stood alone. When child is held upright, will stand 
on toes and not the soles of the feet. Began to 
pull self up at two years of age. Never has been 
alble to sit alone without support. Says only a few 
words. 

Mother also states that patient has a ravenous 
appetite and seems “very greedy.” When playing 
with other children is always biting or scratching 


them. At the age of eight months an attending 
physician informed the mother that the infant’s 
anterior fontanelle was closed. She does not know 
whether it was closed earlier than that or not. 

Past History: Chicken pox at one year of age; 

no other contagious diseases; no illnesses simulat- 
ing encephalitis or meningitis. Pleurisy at three 
months of age but not following any illness. 

Birth History: A nine months child, weight not 

known; cephalic delivery with instruments; no con- 
vulsions or cyanosis. Nursed well during the first 
24 hours; did not cry excessively. 

Family History: Mother living and well; father 

living and well (white). One seven months pre- 
mature child died at one month of age. Three 
other children living and well (same father). No 
tuberculosis contact. 

Examination: Poorly developed and nourished 

and small child for four years of age. Length 34 
inches (normal 38 to 41% inches at four years of 
age). Child lying on examination table, tossing 
body about, flexing feet on abdomen and muttering 
to self. 


144 


Hospital Staff Transactions 


Head showed flat occiput, depressed in fronto- 
parietal region; high vertex. Anterior and pos- 
terior fontanelles closed. Circumference 17% 
inches (normal at four years, 19% to 20% inches). 
Nose prominent; mucoid discharge. Eyes: Pupils 
reacted to light; internal strabismus of left eye. 
Reached for objects and grasped them with good 
co-ordination. Ears: Canals small but deep; both 
tympanic membranes normal. Mouth: 20 milk 
teeth; very high palate; tonsils small, innocent. 
Neck: No glands enlarged. Chest: Rachitic rosary, 
Harrison’s groove. Lungs: No rales, bronchopho- 
phony, or impaired resonance. Heart: No mur- 
murs, arrythmias or enlargement. 

Abdomen: iSpleen and liver not palpated; along 

ascending and descending colon could feel fecal 
concretions. Abdominal muscles markedly relaxed. 

Extremities: The fingers were short and stub- 

by; the foot is in equino-posterier position and 
cannot flex on legs due to shortening of tendo- 
achilles. 

Genitals: Phimosis, both testes in scrotum. 

Skin: No rash. 

Central Nervous System: Knee jerks present 

and normal; Babinski and Brudzinski negative; 
muscles very flabby but no spasticity. Pupils nor- 
mal. Child very evidently mentally unbalanced. 

Laboratory: Wassermann, Kline and Young, 

and Kahn tests negative. Urine shows slightest 
possible trace of albumin; slight trace of indican; 
rare abnormal red blood globule and rare pus cell. 

Diagnosis : Microcephalic idiot. 

Discussion : The features in this case that make 

the diagnosis evident are: (1) Cranial circumfer- 
ence below normal; (2) Flattened occiput with 
recession of fronto-parietal areas; (3) Dwarfism; 
(4) Pointed vertex; (5) High arched palate; 
(6) Prominent nose and the very low grade of 
mentality with inability to walk, sit alone, or talk. 

This defective development has been explained 
by Virchow’s theory of premature ossification of 
the cranial bones, but according to Sachs, is prob- 
ably due to atrophic changes, which are the result 
of hemorrhage or inflammation affecting the brain 
and its membranes. 

Pathology: Brushfield and Wyatt* report the 

pathology of the brains at autopsy of 10 cases with 
evidence of microeephalus as follows: “In every 

case the meninges revealed signs of chronic inflam- 
matory changes. The dura was thickened and 
sometimes adherent to pia-arachnoid and a degree 
of external hydrocephalus was a common feature. 
The lepto-meninges were thickened and opaque with 
a gelatinous exudate extending over the cerebral 

*Brushfie!d and Wyatt: British Journal of Chil- 
dren’s Diseases, March, 1927. 


hemispherese around the sylvian fissures to the 
base. 

“The brains corresponded to the shape of the 
cranium. The under-development of the cerebral 
hemisphere was a striking feature of most of the 
brains. The hypoplasia was most marked in the 
parietal-occiptal bases. The cerebellum was never 
affected to the degree of the cerebrum.” 

Conclusions drawn from the examination of 
these brains was that the underlying causes were 
at work before birth. 


VICKSBURG HOSPITAL STAFF MEETING. 

June 11, 1931. 

Abstract: Ectopic Gestation — Dr. I. C. Knox. 

Patient — Mrs. R. T. R., white, female, married, 
aged 33 years. Admitted to hospital June 6, 1931. 

Family History: Negative except that mother 

had cancer of the cervix. 

Personal History: Patient is a housekeeper by 

occupation; has been married five years. One 
child living and well. General health has been 
excellent. 

Past History: No serious past illness except 

appendicitis, 11 years ago with peritonitis; 
appendectomy performed at that time. Tonsillec- 
tomy performed at that time. Tonsillectomy, 7 
years ago. Patient at the present time has vari- 
cose veins of the legs. 

Present Illness : Patient was diagnosed as being 

pregnant in April, 1931. Condition was not re- 
markable except that the periods returned at the 
regular time each month. The flow was scant and 
lasted only one day. On April 28, the patient was 
washing dishes. She developed a sudden, severe 
pain in the lower right abdomen. Pain was knife- 
like and radiated up the right side. Patient began 
to hemorrhage from the vagina. The flow was pro- 
fuse and had a very foul odor. Patient became 
pale and fainted and was put to bed and given large 
doses of morphine to keep her quiet. Patient soon 
became free of pain, but the flow continued. It 
was scant in amount and exceedingly foul. Patient 
at this time was in Chicago. One week later, the 
patient had a similar attack with the exception 
that the hemorrhage was not profuse. The case 
was diagnosed as abscessed tubes. She had an- 
other attack a few davs later. Patient was 
brought to Vicksburg from Chicago Saturday 
night, June 6, and was operated on Sunday, 
June 7. 

Examination : Examination confined to the 

abdomen. The upper abdomen was entirely nega- 
tive. The lower abdomen showed a mass in the 
rie-ht iliac fossa extending to McBurney’s point. 
The abdomen was very rigid and a mass could be 


Hospital Staff Transactions 


145 


palpated in the right side. Vaginal examination 
revealed a cervix that was flowing slightly, the 
flow being of bloody mucus discharge and not 
profuse. The cervix was somewhat enlarged and 
rather soft. There was no laceration of the cer- 
vix from former pregnancy. The uterus appeared 
rather fixed and there was slight bulging of the 
cul-de-sac. The left side of the abdomen was 
essentially negative. 

Diagnosis: Ruptured right tubal pregnancy. 

Operation: Removal of the right tube and 

hematocele with at least one pint of clotted blood. 

Progress Notes: Patient taken to surgery eight 

o’clock June 7, 1931. Returned from surgery at 
8:40 A. M. Temperature 98°; respiration 32. A 
fairly - comfortable day. Some nausea. June 8, 
1931 temperature 99° ; respiration 20. Patient 
had some slight nausea and some gas pains. This 
was relieved by enema. June 9, 1931. Some 
improvement, pulse, respiration and temperature 
normal. Some nourishment being taken. June 
10, 1931, abdomen flat. Temperature normal. No 
complaints and patient making a nice recovery. 

Discussion: By ectopic pregnancy or gestation 

we mean those conditions in which the growth of 
the impregnated ovum takes place elsewhere than 
in the uterine cavity. There are several locations 
where it may take place, namely, in the tube, in 
the ovary or in the peritoneum. By far the 
greater number of cases of ectopic pregnancy take 
place in the tube and usually in the outer half. 
When the ovum is expelled from the corpus luteum 
of the ovary it is guided by the fimbriae of the 
tube into the canal and by the ciliary processes 
it is waved along into the uterus. 

This passage when unheeded requires several 
days and it is during this process of travel that 
impregnation usually takes place and under nor- 
mal conditions the fertilized egg continues its 
course until it reaches the uterine cavity where 
it becomes implanted or embedded in the endome- 
trium and proceeds to develop into full pregnancy 
at that point. It is assumed and believed by most 
gynecologists that there is some impediment to 
the passage of the ovum that causes it to become 
implanted or embedded in the tube or ovary or 
peritoneum as the case may be. For instance, 
the frequency with which pregnancy is found in 
tubes that have been damaged by some inflam- 
matory process which is the result of puerperal 
infection or gonorrhea, or such conditions as 
appendicitis with adhesions to the end of the 
tube, leads us to believe that these are factors in 
ectopic gestation. However, there are many in- 
stances where this anatomic or pathologic con- 


dition is not found and it is a bit of speculation 
on the part of anyone to say just what causes the 
impregnation of the tube or ovary. Sipple bases 
this theory of causation from observations that the 
ovum may enter the tube on the side opposite to 
the ovary from which it has been discharge. Freund 
thinks that the condition may result from the 
unusual length and convolutions of the tube. How- 
ever, it may be, it is a known fact that an ovum 
cannot live for any great length of time in the 
tube. The death of the embryo is due undoubtedly 
to the poor soil in which the ovum has been fer- 
tilized and inserted. Therefore, it is a rare thing 
for the fetus to live more than two or three months. 
The average time in my experience is about two 
and one-half months. The direct cause of the 
death of the fetus is the rupture of the surround- 
ing capsule. If the bleeding is free and uncon- 
fined, of course, there is great danger of death to 
the mother, but fortunately in the majority of 
cases this is impeded and we have a hematocele 
forming which protects the life of the mother. 

It is hard to determine when we have a tubal 
pregnancy before there is abrupture. Frequently, 
a patient will think that she is pregnant and will 
have the usual symptoms of pregnancy for the first 
month or so. There is frequently a little drainage 
or slight menstruation, as she terms it, which is 
irregular and may continue for about a week, 
then disappear and return. The symptoms of 
rupture are very definite. One of the first symp- 
toms that the patient notices is a sharp, lancin- 
ating pain in the side. This may cause so much 
shock that the patient will frequently fall to the 
floor. Pallor, small rapid pulse and air hunger 
follow. There is no fever, but there is marked 
rigidity of the abdomen and the patient will be- 
come extremely nervous. Very soon after, there 
is almost always some uterine bleeding. RareJy 
ever is this profuse. On palpation, there is rigidity 
and tenderness and frequently a mass is felt which 
is either on the right or left side, more frequently 
on the right. 

Vaginal examination will reveal a mass on either 
side or probably in the cul-de-sac and by frequent 
examination we find the mass getting larger. 
However, I do not think that with the classical 
symptoms of sharp, lancinating pains in the side 
with shock, rapid pulse, air hunger and with a his- 
tory of irregularity of menstruation that we should 
wait, but the patient should be taken to surgery 
and the trouble corrected as soon as possible. It 
matters not when the diagnosis is made, whether 
before rupture, at the time of rupture or after 
rupture, the course to pursue is surgery with re- 
moval of the tube and hemorrhage controlled in 
that way. 


LOUISIANA STATE MEDICAL SOCIETY NEWS 

H. Theodore Simon, M. D., Associate Editor. 


Resolution adopted at a meeting of the Orleans 
Parish Medical Society, July 13, 1931. 

In the death of Dr. Robert Clyde Lynch the 
Orleans Parish Medical Society has lost one of its 
most distinguished members. The sudden crushing 
out of this valuable life in an automobile acci- 
dent represents an overwhelming blow and irre- 
parable loss to our profession and to the com- 
munity. His great skill, remarkable dexterity, 
and sound surgical judgment made him a leader 
in devising new procedures in his field of endeavor. 
His clearness of thinking and precision in demon- 
stration were those of a great teacher. His firm- 
ness combined with tact led others to look to 
him as an administrator, organizer, and leader. 
His quiet manner and his fine qualities of char- 
acter bound many to him by the ties of friendship. 
Above all, he was a great doctor, with sympathy 
and gentleness for suffering, with utter devotion 
to duty. 

It is fitting, therefore, that this Society should 
record this in its minutes as an indication of its 
sorrow and bereavement, and that a copy should 
be sent to Dr. Lynch’s family as a mark of the 
high regard in which he was held by colleagues 
and friends. 


Resolution adopted at a meeting of the Orleans 
Parish Medical Society, July 13, 1931. 

Whereas the Orleans Parish Medical Society has 
sustained a great loss in the death of Dr. B. A. 
Ledbetter ; 

Be it resolved that a page of the minutes be 
devoted to his memory. Dr. Ledbetter was for 
many years a prominent figure in the medical pro- 
fession of the city and the state. He had served 
this society as its President, and was later presi- 
dent of the Louisiana State Medical Society. 
Through a long period of years he was on the 
staff of the Charity Hospital, and he had twice 
served as a member of the Louisiana State Board 
of Health. In these capacities he was active and 
forceful, and bent every effort to forward the in- 
terests of the profession and to promote the public 
health and welfare. His cheery disposition 
brought him the attachment and confidence of a 
large circle of friends. 

Be it further resolved that this society tender 
to Dr. Ledbetter’s family this expression of its 
appreciation of Dr. Ledbetter’s active service, and 
of its sorrow at his death. 


UNITED STATES PUBLIC HEALTH 
SERVICE. 

Asst. Surgeon Charles W. Folsom. Relieved from 
duty at New Orleans Quarantine Station, and 
assigned to duty at Marine Hospital, New Orleans, 
La. June 30, 1931. 

Asst. Surgeon J. G. Pasternak. Relieved from 
duty at New Orleans, La., on or about July 6, and 
assigned to duty at National Institute of Health, 
Washington. June 30, 1931. 

Assistant Pharmacist F. L. Gibson. Relieved 
from duty at Carville, La., on or about July 10, 
and assigned to duty at Marine Hospital, Boston, 
Ma;ss. June 16, 1931. 

Chief Pharmacist D. J. Gleason. Relieved from 
duty at Marine Hospital, Boston, Mass., on July 
10, and assigned to duty at Marine Hospital, Car- 
ville, La. June 16, 1931. 

A. A. Surgeon C. P. Munday. Relieved from 
duty at Carville, La., on June 30 and assigned to 
duty at Relief Station, Port Arthur, Texas. June 
16, 1931. 

A. A. Surgeon Harry H. East. Relieved from 
duty at Port Arthur, Texas, on June 30, 1931, 
and assigned to duty at Marine Hospital, Carville, 
La. June 16, 1931. 

Asst. Surgeon Fred P. Burow. Relieved from 
duty at Marine Hospital, New Orleans, La., on 
July 6, and assigned to duty at Quarantine Sta- 
tion, New Orleans, La. July 1, 1931. 

Asst. Surgeon D. W. Patrick. Relieved from 
duty at Marine Hospital, New Orleans, La„ on July 
6, and asigned to duty at Quarantine Station, New 
Orleans, La. July 1, 1931. 

Asst. Surgeon Noka B. Hon. Directed to pro- 
ceed from New Orleans, La., to Hot Springs, Ark., 
for special temporary duty at Public Health Serv- 
ice Clinic at that place. July 2, 1931. 

Asst. Surgeon George J. Van Dyke. Relieved 
from duty at Marine Hospital, New Orleans, La., 
on July 6, and assigned to duty at Marine Hospital, 
Cleveland, Ohio. July 2, 1931. 


Dr. Leon J. Menville, Editor of Radiology, was 
elected Vice Chairman of the Section of Radio- 
logy at the recent meeting of the American Medi- 
cal Association. Dr. Menville was also recently 
appointed to serve on a sub committee on Electrical 
Definitations, American Standard Association, 
sponsored by the American Institute of Electrical 
Engineers. 


Louisiana State Medical Society 


147 


Dr. John H. Musser has been appointed to the 
Medical Council of the U. S. Veterans’ Bureau. 

ANNOUNCEMENT. 

TENTH ANNUAL SESSION 
American Congress of Physical Therapy 
October 5, 6, 7, 8, 1931 
Hotel Fontenelle Oma 1 a, Nebraska. 

The tenth anniversary session of the American 
Congress of Physical Therapy will be held October 
5, 6, 7, 8, 1931 at the Hotel Fontenelle, Omaha, 
Nebraska. The Congress has always endeavored 
to present a program of high quality, and while 
each year has seen a steady improvement, this 
year’s program is of such a standard that it will 
be difficult to surpass in the future. Appreciating 
the desirability of clinics and clinical demonstra- 
tions, the program committee has set aside the 
mornings for these purposes. It will be the first 
time that the society will have available ample 
clinical material for medical and surgical services. 
The cooperation of the University of Nebraska, 
College of Medicine, and the Creighton University 
School of Medicine has made this possible. 

For preliminary program and other information 
write to the American Congress of Physical Ther- 
apy, 30 North Michigan Avenue, Chicago, Illinois. 


HEALTH OF NEW ORLEANS. 

The Division of Vital Statistics of the United 
States Department of Commerce reported for the 
week ending June 30, 1931, that there was a total 
of 126 deaths equally divided between the white 
and colored, and in the corresponding week of 
1930, 150 deaths. The death rate for the week 
was 14.1. The infant mortality for this week was 
33 white and 140 colored. For the week ending 
June 27, 1931, the total deaths were 126, of 
which 77 were white and 49 colored. The infant 
mortality had decreased to 58 white and 65 colored 
deaths under one year per 1,000 live births. The 
total number of deaths in the corresponding week 
in 1930 was 190. The index for the week ending 
July 4, 1931 shows a total mortality of 175, 105 
white and 70 colored as contrasted with 129 total 
deaths in the corresponding week of 1930. Infant 
mortality had increased to white 61 and colored 
116. For the week ending July 11, 1931 the total 
deaths had decreased to 159, 90 white and 69 col- 
ored. The infant mortality rate was white 99 and 
colored 147. 


INFECTIOUS DISEASES IN LOUISIANA. 
From the office of the United iStates Public 
Health Service, in collaboration with Dr. J. A. 
O’Hara, the morbidity weekly report for the 25 
weeks ending June 20, 1931 shows the greatest 


number of cases reported under the heading of 
pulmonary tuberculosis, 54, and syphilis 54. Among 
the other prominent infectious diseases is diph- 
theria with 25 cases, twenty-three cases of gonor- 
rhea, 38 cases of pellagra, and 17 cases of typhoid 
fever. These cases of typhoid fever were reported 
from 11 parishes. There was a decrease in the num- 
ber of typhoid fever cases reported in comparison 
with the corresponding week of 1930 when 27 
cases were reported. There were 9 reported cases 
of smallpox, four in the parish of Orleans. There 
was one reported case of undulant fever in Lafay- 
ette parish. 

For the week ending June 27, 1931, pellagra led 
the list with 67 cases. Syphilis accounted for 55 
cases as contrasted with 120 cases in the corre- 
sponding week of 1930. Typhoid fever had in- 
creased to 34, being reported from 16 parishes with 
the greatest number, 8, in Evangeline parish. There 
were 2 reported cases of poliomyelitis and a re- 
ported case of undulant fever, this time in Iberville 
Parish. Smallpox had decreased to 2 cases, one in 
Orleans Parish and one in East Baton Rouge 
Parish. 

For the week ending July 4, 1931 there were 
89 cases of pneumonia reported as contrasted with 
21 cases in the corresponding week of 1930. 
Typhoid fever cases had decreased to 25 cases in 15 
parishes. There was only one case of epidemic 
cerebrospinal meningitis in Orleans Parish and one 
case of poliomyelitis in Ouachita parish. There 
were 56 cases of pellegra reported. For the week 
ending July 11, 1931 there were 91 cases of pellegra 
reported, said to be the result of a survey covering 
several parishes for several months. Pneumonia 
showed the next largest number with 72 reported 
cases. There were 47 typhoid fever cases re- 
ported. Two cases of undulant fever from Wash- 
ington parish, and one case of tularemia from the 
same parish were reported. Only 9 cases of small- 
pox were reported in this week and only 18 cases 
of syphilis as contrasted with 55 for the previous 
week. 


CORRESPONDENCE. 

MEDICAL ORGANIZATION. 

In the last issue of the Journal, the President of 
our State Medical Society expressed himself as 
desiring a closer contact with the officers of the 
component associations, saying that he would like 
very much to get their views, as well as that of 
every legally qualified physician of the State re- 
garding organization, medical economics and in 
fact anything relating to the welfare of our pro- 
fession. Hence this from me, as President of the 
■Sixth District Medical Society. When Dr. Barrow 
was made our President, I felt that a man had 


148 


Louisiana State Medical Society 


been chosen, who had sufficient strength of char- 
acter and that he would bring honor to the medi- 
cal profession, as well as advancement to organized 
medicine. His article in the last issue proved I 
was correct; it shows that he is not afraid of 
opinion, irrespective of traditions, when he feels 
he is right. It is a pity this article could not be 
broadcasted through all medical Journals and 
especially through the Journal of the A. M. A. My 
views of economics, organized medicine and tra- 
ditions are in hearty accord with this. The econo- 
mic side of the life of today cannot be compared 
to that of many years ago, advancement in every- 
thing is such that we must meet the situation boldly 
and frankly. The financial side of the life of the 
physician must be improved in some way and 
manner to meet the needs as they are today and 
to accomplish this without being censured the phy- 
sicians in their organizations must do away with 
certain traditions hung on to us by medical ethics. 
Our ethics are too antiquated and unless they are 
revised, so as to bring them up to the high stand- 
ards of the medical profession and to meet the 
necessities of the physician to enable him to live 
in fair comfort, something is bound to happen. 
Organized medicine in its true meaning is the only 
hope and salvation for us and let us live up to its 
every purpose as brave and honest men. Do not 
let any of us use it for purely personal and selfish 
purposes. Let advancement and high standards 
be our watch words and above all let us stand 
by each other in organized medicine as a solid 
phalanx. We are in an age of specialism in the 
medical profession; let us live up to the meaning 
of that word to its fullest and let us “eunuchize” 
all traitors and hybrid specialists. We should 
know that it is our duty to refer all patients, not 
belonging to our specialty, when coming to us, to 
a brother specialist in a different branch where 
the patient belongs. But I ask “is this done?” I 
answer a thousand times, “No!” And such acts 
are wrong to the very fundamentals of organized 
medicine. Let us clean our house along these lines 
and keep it clean if possible. This has no reference 
to and bears no reflection on the general practition- 
ers; they are more loyal to their brother special- 
ists by much, than are the specialists towards each 
other and vice versa. I consider that the most 
charitable and honorable as a whole of all medical 
men are the general practitioners. 

Tradition is a wonderful word yet many tra- 
ditions in all professions and occupations, except 
those of the medical profession have been put 


by the advancement of science, inventions, and dis- 
coveries. Why should this not also be done judici- 
ously in our medical ethics as suggested by our 
able President. 

Traditions, customs and habits of civilization have 
almost the same meaning in many instances. Up to 
twenty-five years ago it was traditional for old Dob- 
bins and the two-wheel sulky to be handed down, 
when the family doctor died, to his successor who 
came to replace him. This tradition or custom has 
rightfully passed on, yet many traditions respected 
by the medical profession are almost as ludicrous. 
In our ethics we yet have many traditions that are 
beautiful and will always be honored but in many 
ways our code can be vastly improved to meet the 
modern times. We should get together and stand 
by our President along these lines so that the 
bold and honest stand he has taken will be carried 
on by others. I am afraid that there are few of 
us who would criticise adversely an editorial in 
the A. M. A. Journal yet our President, feeling 
that he was right, did just this thing and too much 
commendation cannot be given him for the stand 
he has taken — it is due him. 

It is a great pity that the medical fraternity in 
many of our small and thinly populated parishes 
are too small in numbers to organize a society and 
Dr. Barrow suggests, the District Society should 
seem the most suitable gateway for them to enter 
organized medicine. But before this is done these 
district societies must be put on a business stand- 
ard. Again that word economics comes in like 
Banquo’s Ghost, it won’t down. I have just gotten 
the reins as President of the Sixth District Medical 
Society and our Secretary informs me that the 
member of this Society pay only when they attend 
the meetings and even this is not done in some 
instances. Before my term of office is over I do 
hope to have this entirely changed so that it will 
be as business-like as is our state society, which 
we know could not be improved upon under the 
management of Dr. Talbot. Our physicians must 
be improved as business men in some way and 
learn the meaning of the word budget in finances. 

Respectfully, 

F. F. Young, M., D. 

President Sixth District Medical Society, Coving- 
ton, Louisiana. 


MISSISSIPPI STATE MEDICAL ASSOCIATION NEWS 

L. S. Lippincott, Editor 

Jacob S. Ullman, Associate Editor D. W. Jones, Associate Editor 


THAT WE MAY KNOW EACH OTHER 
BETTER. 

Dr. James Milton Acker, Jr., Aberdeen, the Pres- 
ident-Elect of the Mississippi State Medical Associ- 
ation, was born in 1887 and has been practicing 
medicine 21 years. Graduating from high school 
in Aberdeen, he had 
three years of literary 
study and two years of 
medicine at the Univer- 
sity of Mississippi, and 
was graduated in medi- 
cine from the Tulane 
University of Louisi- 
ana, School of Medicine 
in 1910. He was licen- 
sed to practice medicine 
by the Mississippi State 
Board of Health the 
same year and has 
spent his life in Aber- 
deen With the exception 
of two years in the 
army and time spent in 
post-graduate work. He 
entered the army as a 
first lieutenant and was 
discharged as a major 
after serving most of 
the time as regimental 
surgeon of the 309th 
Field Artillery, 78th 
Division. He spent 
four months in 1912 at 
the New York Poly- 
clinic and had post- 
graduate study at Chi- 
cago and the Mayo 
Clinic in 1928. Dr. 

Acker has been Secre- 
tary of the Northeast 
Mississippi Thirteen 
County Medical Society 
for five years, is a mem- 
ber of the Mississippi 
State Medical Associa- 
tion and a fellow of the 
American Medical Association. 


PAPERS FOR PUBLICATION. 

Dear Mr. Editor: 

Had I not had the honor of meeting your dis- 
tinguished co-worker Dr. J. S. Ullman, I would 
think he must be of Hibernian ancestry. In the 
July Journal he writes under the heading “Papers 


for Publication,” and occupies rather more than 
half a page telling what papers should not be pub- 
lished. 

Asked for advice how to write, a successful 
author once said: “Write about new things in 
an old way, old things in a new way, or new 
things in a new way. 
Never write about old 
things in an old way.” 
The last sentence covers 
what Dr. Ullman has 
to say in his half page, 
and expresses it with 
much less waste of ink 
and space. 

The Journal has re- 
cently been giving us, 
under the heading 
Hospital Staff Transac- 
tions, some extremely 
readable stuff : case re- 
ports. As Dr. Ullman 
suggests, there are 
such things as text 
books that are avail- 
able to us all; but since 
no two patients are 
ever exactly alike, we 
have in the clinical 
case the “new thing,” 
or at least the unre- 
corded things, that will 
enable us to write in 
one of the three per- 
mitted ways. Formerly 
such subjects appeared 
much more frequently 
on programs and in 
journals than they do 
today and their absence 
is a distinct loss. Why 
not try to revive them 
more generally? 

E. F. Howard. 


HISTORY OF THE MISSISSIPPI STATE 
MEDICAL ASSOCIATION. 

At the last meeting of the Mississippi State Med- 
ical Associationfi Dr. E. F. Howard, Vicksburg, was 
elected Historian. He is now hard at work in an 
effort to bring up to date the history of the As- 
sociation published under his direction in 1910. 
In the interest of accuracy, items of history will be 



JAMES MILTON ACKER, JR., M. D., 
Aberdeen, Miss. 

President-Elect, Mississippi State Medical 
Association. 



150 


Mississippi State Medical Association 


published in these columns. Dr. Howard requests 
that every member of the Association go over 
these items carefully and suggest to him any addi- 
tions and corrections that should be made. Co- 
operation on the part of the members of the As- 
sociation will insure a dependable and interesting 
history to be published later in book form. 

Add 1908: 

Dr. W. H. Aikman, on behalf of the Adams 
County Medical Society, presented the Association 
with a gavel “composed of five pieces of wood held 
together by bands of silver; the bands at the ends 
being expanded to extend over the different pieces 
and on these expanded surfaces at one end is en- 
graved the names of the places where the wood was 
grown or whence it came. At the other end, on the 
corresponding surfaces, are recorded events, names 
and dates that make these five places notable in 
local history. Beginning at the handle we have a 
piece of red cedar from “Windy-Hill Manor,” 
where that adventurous character of American 
history, Aaron Burr, was concealed in 1807. Next 
a piece of white cedar from a large tree that grew 
on “The Briars,” where Jefferson Davis was mar- 
ried February 26, 1845. Then a section of poplar 
from “Longwood,” where Sergeant L. Prentiss was 
married on March 2, 1842, and where he died July 
1, 1850. Next a piece of walnut from “Concord,” 
where stood the residence of the last Spanish gov- 
ernor, Gayoso, this residence being built in 1789. 
The piece of hickory and the hickory handle grew 
on “Monmouth,” the home of General John A. Quit- 
man, a hero of the Mexican war and military gov- 
ernor of the City of Mexico, being made governor 
by General iScott in recognition of his valor in 
being the first to have his troops within that anci- 
ent citadel.” (Transactions, 1908). 

Add 1909: 

This year marks the beginning of the defense 
bureau. Such work had been begun with consider- 
able success by several State Associations and it 
was the opinion of Dr. J. W. Gray, the 1908^9 
president, that such a feature would be of benefit 
in Mississippi. His advocacy of it was the first 
suggestion of the plan which, finally adopted in 
1911, has become so important a part of our ma- 
chinery. 

As a matter of no small satisfaction was the 
opportunity to show appreciation of one of the 
martyrs to medical science. The organized pro- 
fession of the country was raising a fund to pur- 
chase a home for the widow of Dr. James Carroll, 
whose death was directly attributable to an attack 
of yellow fever contracted voluntarily in the effort 
to demonstrate the transmission of the disease 
by mosquitoes. The Association appropriated one 
hundred and fifty dollars for this purpose, to 


which the individual members present at the meet- 
ing contributed an equal amount. 

1911. — This defeat, however, but served to stimu- 
late the Association to greater efforts. Dr. H. L. 
Sutherland of Rosedale initiated the attack with 
a paper on “The Duty of the State in the Conserva- 
tion of Human Life and Energy,” which was pre- 
sented at the annual session and given to the pub- 
lic press. The various matters in which the As- 
sociation had met defeat in the legislature were 
re-introduced and energetically pressed and the 
following year (1912) the legislative committee 
was able to report complete success with every 
measure introduced. The appropriation for the 
State Board of Health was increased from eight 
to twenty-five thousand dollars, a Bureau of Vital 
Statistics was created, and a law was passed pro- 
viding that only graduates of recognized medical 
schools might apply for license to practice. 


COUNTY EDITORS. 

Dr. R. G. Grant of the North Mississippi Medi- 
cal iSociety has made the following appointments 
to the Board of County Editors representing the 
counties of the North Mississippi Medical Society: 
Dr. A. H. Little, Oxford, Secretary, Chairman of 
the Board; Dr. Frank Ferrell, Ashland, Benton 
County; Dr. F. E. Linder, Taylor, Lafayette 

County; Dr. D. R. Moore, Byhalia, Marshall 

County; Dr. G. H. Wood, Batesville, Panola 

County; Dr. C. M. Murry, Ripley, Tippah County; 
Dr. H. P. Boswell, New Albany, Union County; 
Dr. G. A. Brown, Water Valley, Yalobusha County. 


LOAN OF TRANSACTIONS. 

June 24th. 

Dear Mr. Editor: 

The Historian wishes the loan of three volumes 
of TRANSACTIONS for the years 1895, 1898 and 
1899. Perhaps if you will insert a request in the 
news column of the JOURNAL, some of the 
members will help him out. Only as a loan, to be 
returned promptly. 

Very truly yours, 

E. F. Howard. 


PANOLA COUNTY. 

Dr. Malcolm Arnold and wife of Sardis, are at 
home for a few weeks’ visit to relatives and 
friends. Dr. Arnold has just graduated from 
Johns Hopkins and goes to his work in the 
Naval Hospital at Washington, D. C., the last of 
June. 


G. H. Wood. 


Mississippi State Medical Association 


151 


JOINT MEETING. 

More than 200 North Mississippi physicians at- 
tended the regular quarterly meeting of the North- 
east Mississippi Thirteen County Medical Society 
at Houlka, on June 22, with members of the North 
Mississippi Medical Society and high state officials 

special guests. Dr. C. E. Boyd, president of the 
Northeast Mississippi Society, Dr. J. M. Acker, 
Jr., Secretary, and others in charge of the program, 
had declared the occasion “Houlka Day” in honor 
of one of the hospitable town’s most distinguished 
citizens, Dr. William C. Walker, beloved member 
of the organization. 

The ladies of Houlka served a bountiful picnic 
dinner to the doctors in a grove near the Baptist 
Church, the place of the quarterly meeting. Miss 
Moss Davis welcomed the doctors to Houlka. 

The session as called to order by President Boyd. 
Rev. S. P. Andrews, pastor of the Houlka Baptist 
Church, pronounced the invocation. Dr. Z. A. Dor- 
sey presented a paper on “Focal Infection.” Dis- 
cussion was opened by Drs. Pegram and Guinn. 
Dr. A. H. Little’s paper, “Report of Allergic 
Cases,” brought general discussion. Among the 
outstanding physicians on the program was Dr. 
Percy Toombs of Memphis. He discused, “Dys- 
tocia, With Special Reference to the Occiput Pos- 
terior.” “Differential Diagnosis of Heart Mur- 
murs in Children,” was the subject of Dr. R. E. 
Priest’s paper. The discussion was opened by Dr. 
Reed and Dr. Adams. 

At the conclusion of the regular program Dr. 
John C. Culley, President of the Mississippi State 
Medical Association was presented. He paid his 
respects to Dr. William C. Walker in whose honor 
the meeting was held and a tribute to the late Rad 
Reed. Discussing the work of the State Medical 
Association, Dr. Culley pointed out that this body 
at its last meeting in Jackson had endorsed by reso- 
lutions the movement to secure funds from the 
State to maintain charity wards in community hos- 
pitals and privately owned hospitals in order to 
care for charity patients in their territory. No 
definite plan has yet been adopted by the Associ- 
ation but this will be left with a committee ap- 
pointed by the President and composed of a mem- 
ber from each congressional district. The follow- 
ing will compose the committee: Dr. R. B. Cald- 
well, Baldwyn; Dr. V. B. Philpot, Houston; Dr. 
C. M. Speck, New Albany; Dr. E. R. Nobles, Rose- 
dale; Dr J. W. D. Dicks, Natchez; Dr. J. P. Cul- 
pepper, Hattiesburg; Dr. M. L. Flint, Newton. The 
chairman of the committee is Dr. Felix J. Under- 
wood, executive officer of the Mississippi State 
Board of Health. 

Dr. Culley, in closing his address made an appeal 
to the members of the profession to forget faction- 


alism and to work together for the restoration of 
the University of Mississippi to its former stand- 
ing in the Southern Association of Colleges, thus 
assuring the continuation of the medical school at 
Ole Miss in its A-l rating. He explained that the 
reason the medical school was not suspended but 
placed on probation was because of the board of 
trustees reinstating all the members of the medi- 
cal faculty who had been previously removed, and 
the placing as dean of a man who was qualified to 
fill the office because of his understanding of medi- 
cal education. Dr. P. L. Mull, dean of the Ole Miss 
Medical School, was then introduced. He spoke 
briefly of the work for the coming session. 

The last speaker was Dr. Felix J. Underwood of 
the State Board of Health and President of the 
Southern Medical Association. 

Among others attending the meeting were the 
president-elect of the State Medical Association, 
Dr. James M. Acker, Aberdeen; Ex-President- G. S. 
Bryan, Amory; and Ex-President P. W. Rowland, 
Oxford. Dr. Underwood is also an ex-president of 
the State Association. 


WEBSTER COUNTY. 

Drs. W. H. Curry and J. H. Brown of Europa 
attended the Winona District Medical Society 
meeting at Lexington, July 6. Thirty physicians 
were present and a splendid program was ren- 
dered. 

An invitation was extended to the Society to 
hold its next meeting in Europa. 

W. H. Curry, County Editor. 


YAZOO COUNTY. 

I am sorry I mentioned corn in my June report 
for some unknown reason only two Yazoo doctors 
attended the last meeting of the Central Medical 
Society, Dr. Joe Roberts, Thornton, and your 
scribe. Dr. John Darrington attended the meeting 
of the State Board of Health recently of which he 
is a valuable member. 

I hope to meet all Yazoo doctors in Vicksburg 
on the fourteenth. 

C. M. Coker, County Editor. 


PONTOTOC COUNTY. 

Here goes from Pontotoc County Again: 

Dr. C. D. Mitchell, Jackson, Superintendent of 
the State Hospital for the Insane, was a very pleas- 
ant visitor to our county on a recent visit to North 
Mississippi. 

Dr. A. H. McGregor, Randolph, in the south- 
western part of the county is very busy at this 


152 


Mississippi State Medical Association 


time. Dr. J. D. Neel and the writer held a very 
interesting consultation with him recently. 

Dr. Donaldson, Health Officer of this county, has 
been re-appointed for another two years. He is 
busy now with typhoid vaccinations and the like. 

Pontotoc county was honored recently by a visit 
from Dr. R. N. Whitfield of the State Board of 
Health. During his stay in Pontotoc county, a 
Vital Statistics Associtaion was organized. The 
following doctors of the county were present: O. F. 
Carr, R. P. Donaldson, Z. A. Dorsey, J. D. Neel, 
J. H. Windham, J. W. Gillespie, J. W. Turner, and 
E. B. Burns. 

E. B Burns, County Editor. 


CLAIBORNE COUNTY. 

We are glad to report that Dr. E. D. Barron, 
Pattison, is able to be out again, following an ill- 
ness of several weeks. 

Dr. D. M. Segrest, Lieutenant, United States 
Navy, who has been stationed at the Naval Hos- 
pital, Washington, D. C., is visiting his parents, 
Dr. and Mrs. R. A. Segrest, at Port Gibson. 

At the recent meeting of the State Board of 
Health, Dr. W. N. Jenkins, Port Gibson, was 
reappointed health officer for Claiborne County. 

W. N. Jenkins, 
County Editor. 


WINSTON COUNTY. 

Dr. Bernard Hickman, son of Dr. W. W. Hick- 
man, Louisville, recently took unto himself a bride, 
and has moved to our city as a partner of his 
father. 

Dr. M. L. Montgomery recently camped for a 
week, not on a fishing outing, but while having 
his home remodeled. We seemed to have the sym- 
pathy of our friends but that did not eliminate 
the worries of trying to remain while the work 
was in progress. 

The Winston County Medical Fraternity meets 
in regular session the second Tuesday night of 
each month. 

Dr. W. W. Parks of our city has procured the 
services of Dr. R. L. Donald of Jackson as a 
partner. He and his good lady having moved into 
our city, there they will reside, and Dr. Donald 
will do general practice. 

We are having distressingly good health through 
this section, but we appreciate health if it does 
cause more idleness among us. 

M. L. Montgomery, 

County Editor. 


MADISON COUNTY. 

Dr. John B. Howell of Canton was operated 
upon at the Jackson Infirmary in June. He is at 
home now where he is convalescing rapidly. 

Dr. and Mrs. John Melvin of Camden have re- 
turned from Baltimore where Mrs. Melvin went 
for treatment. Mrs. Melvin is much improved in 
health. 

Miss Stevens, nurse at the King’s Daughters’ 
Hospital of Canton, is enjoying a vacation at home. 

A. P. Dufrey, 
County Editor. 


GRENADA COUNTY. 

Affairs medical in Grenada county are in normal 
condition. Our doctors are well and at work as 
opportunity offers. No marriages, births or deaths 
in their families except my own. We sustained a 
sore bereavement in the death of our son-in-law, 
Mr. Frank B. Hays, at the Methodist Hospital in 
Memphis on June 11. He was indeed a fine son. 

Our local society — Winona District — had a most 
delightful meeting at Lexington on July 6. A full 
program and free discussion was enjoyed by 
30 or more members. The doctors, druggists, and 
citizens generally made us welcome and proved 
themselves to be royal hosts. A splendid, well- 
served luncheon added to the enjoyment of the 
“inner man.” A “red letter” day for us. Drs. 
J. K. Avent, R. A. Clanton and T. J. Brown 
represented Grenada County. 

T. J. Brown, 
County Editor. 


COMMITTEE ON COMMUNITY HOSPITAL 
LEGISLATION. 

At a meeting of the Committee on Community 
Hospital Legislation of the Mississippi iState Medi- 
cal Association at Jackson, on July 7, the follow- 
ing action was taken: 

“In keeping with a resolution, a copy of which 
is herewith enclosed, adopted by the Mississippi 
State Medical Association in annual meeting which 
assembled at Jackson in May, 1931, pertaining to 
Legislation regarding the distribution of charity 
funds to community hospitals in counties where no 
state hospitals exist, we, the Committee on Com- 
munity Hospital Legislation, appointed by the 
President of the Mississippi State Medical Asso- 
ciation, wish to submit to all candidates for 
governor, lieutenant-governor, and the legislature, 
the following: 

“In view of the fact that the Mississippi State 
Medical Association has adopted by unanimous 
vote the enclosed resolution it is to you we are 
appealing for legislation to carry out this program. 


Mississippi State Medical Association 


153 


May we ask that you give this important matter 
your careful consideration and, if it meets with 
your approval, carry this idea to your people. 
Also, we should appreciate information as to your 
attitude on this important legislation.” 

Felix J. Underwood, M. D., Jackson, Chairman. 

V. B. Philpot, M. D., Houston, Secretary and 
Representative District Four. 

R. B. Caldwell, M. D., Baldwyn, District One. 

C. M. Speck, M. D., New Albany, District Two. 

E. R. Nobles, M. D., Rosedale, District Three. 

M. L. Flynt, M. D., Newton, District Five. 

J. P. Culpepper, M. D., Hattiesburg, District 
Six. 

J. W. D. Dicks, M. D., Natchez, District Seven. 

R. W. Smith, M. D., Canton, District Eight. 


EAST MISSISSIPPI MEDICAL SOCIETY. 

The regular meeting of the East Mississippi 
Medical Society was held in the Benwalt Hotel, 
Philadelphia, Thursday, June 18, at 3 P. M., with 
27 members and 13 guests present. The following 
program was rendered: 

1. The Present Understanding and Limitations 
of the Term Eczema— Dr. R. W. Hall, Jackson. 

Discussed by Dr. E. C. Mitchell, Memphis. 

2. The Patient— Mrs. Iva W. Lovell, Superin- 
tendent of Nurses, Meridian (Sanitarium. 

3. Symptoms of Colon Disfunction — Dr. H. G. 
Rudner, Memphis. 

Discussed by Drs. E. C. Mitchell, H. C. Ricks 
and J. S. Hickman. 

4. Motion Pictures Showing Activities of a 
County Health Department as Operated in 
Mississippi — Dr. H. C. Ricks, Jackson. 

Immediately following the meeting, through the 
courtesy of the Neshoba County doctors, a banquet 
was served to the members and guests. Dr. A. L. 
Majure served as toastmaster. The speakers were 
Drs. E. C. Mitchell, R. W. Hall, H. G. Rudner 
and H. C. Ricks. 

T. L. Bennett, Secretary. 

WARREN COUNTY. 

Dr. M. H. Bell is enjoying a much needed 
vacation. He will remain out of his office until 
August 1. 

Dr. and Mrs. W. G. Weston, formerly of Louis- 
ville, Ky., have moved to Vicksburg. Dr. Weston 
is connected with the Vicksburg Clinic, his prac- 
tice being limited to Internal Medicine. 


Dr. and Mrs. George M. Street attended the 
recent meeting of the American Medical Asso- 
ciation. 

Dr. Guy P. Sanderson has entered private prac- 
tice. He retains his position on the Staff of the 
Vicksburg Hospital and was elected President at 
its recent meeting. 

Dr. J. A. K. Birchett, Jr., recently enjoyed 
spending a few days at the Mayo Clinic. 

Dr. and Mrs. Guy C. Jarratt have returned from 
their vacation, which they spent in Oklahoma City. 

Dr. W. E. Akin has accepted a position as resi- 
dent physician at the Vicksburg Hospital. 

Drs. Walter Johnston and Gurney Clark re- 
ceived their degrees at Vanderbilt University 
during June. Dr. Johnston has entered private 
practice with his father, Dr. iS. W. Johnston. 
Dr. Clark has secured an internship at the Strong 
Memorial Hospital of Rochester, N. Y. ; he plans 
to specialize in internal medicine. 

Dr. Sol Kaufman spent a few days in Vicksburg 
during his vacation. He has returned to Charity 
Hospital of New Orleans, La., for a Senior In- 
ternship. 

Dr. Nathan Lewis has returned to Vicksburg, 
after having received special training in surgery at 
the Missouri Pacific Hospital, St. Louis, Mo. He 
will spend the next two weeks at the Reserve 
Officers’ Training Camp, after which he plans to 
enter private practice. 

Dr. Edley H. Jones has been notified of his elec- 
tion as a Fellow of the American College of Sur- 
geons. The degree will be conferred at the annual 
convocation in October. 

Three Vicksburg boys, Alston Callahan, John 
Whitney and Benson Martin have completed their 
second year of medicine. Callahan is spending the 
summer at the Vicksburg Hospital and Martin at 
the Vicksburg Infirmary. 

Edley H. Jones, 
County Editor. 


VICKSBURG HOSPITAL. 

The regular monthly staff meeting of the Vicks- 
burg Hospital was held on June 11 at 7 P. M. and 
was called to order by the President, Dr. W. H. 
Parsons, with the following present: Drs. I. C. 

Knox, G. P. Sanderson, H. W. Weimar, F. M. 
iSmith, E. H. Jones, and W. E. Akin. 

After the reading of the minutes of the two 
preceding meetings, and analysis of the work of 
the hospital for the past month, including roent- 


154 


Mississippi State Medical Association 


gen-ray, laboratory, medical and surgical reports, 
made and the reports freely discussed. There was 
free discussion of the twenty-five questions for 
hospital standardization as outlined by the Ameri- 
can College of Surgeons. 

The scientific program included a case report 
and discussion of “Ectopic Gestation,” lead by 
Dr. I. C. Knox. 

Election of officers was held and the following 
elected to serve until the meeting in February, 
1932: President, Dr. G. P. Sanderson; vice-presi- 

dent, Dr. W. H. Parsons; secretary, Dr. Yv T . E. 
Akin. 

Refreshments were served and the meeting 
adjourned. 


PIKE COUNTY. 

Born to Dr. and Mrs. H. C. Hatcher, a son, on 
June 17, 1931. 

Dr. L. W. Brock was forced to stay in bed a 
few days from an infected hand. Glad to say he 
is at work again. 

Dr. T. B. Abney has located at McComb. 

Dr. T. Paul Haney of the Commonwealth Health 
Unit is with us and will soon be able to show us 
just how it should be done. We are with you, doc. 

L. J. Rutledge, 
County Editor. 


VICKSBURG SANITARIUM. 

The regular monthly meeting of the staff of the 
Vicksburg Sanitarium was held July 10. 

After the reading of the minutes of the last 
meeting and the reception of reports from the 
records department and analysis of the work of 
the hospital, the following special case reports 
were made: 

1. Microcephalus — Dr. G. C. Jarratt. 

2. Fracture of the Shaft of the Radius with 
Poor Apposition and Delayed Union, Treated by 
Open Reduction and Intramedullary Bone Peg — 
Dr. A. Street. 

3. Postoperative Phlebitis of the Lower Ex- 
tremities — Dr. J. A. K. Birchett, Jr. 

4. Some Interesting Chest Conditions — Dr. L. J. 
Clark. 

5. Ovarian Cyst — Donald S. Hall. 

Dr. G. M. Street reported on the recent meet- 
ing of the American Medical Association at 
Philadelphia. 


A number of interesting roentgen-ray studies 
were presented and discussed. 

Closed with a lunch. 


NESHOBA COUNTY. 

The Neshoba County Medical Fraternity met on 
its regular date in June. We had a very enthu- 
siastic little meeting and enjoyed the mingling 
together of the dentists, pharmacists and medical 
men. We had the following papers and dis- 
cussions: 

Trench Mouth — Dr. E. P. Tolbert. 

Discussed by Drs. Porter Jordan, R. H. Gully, 
W. R. Hand, and J. S. Hickman. 

Tularemia — Dr. J. S. Hickman. 

Discussed by Dr. W. R. Rand. 

Dinner was served at Dobb’s Hotel. 

The East Mississippi Medical Society met at the 
Ben Walt Hotel, Philadelphia, on June 17. We 
had a very instructive meeting, after which the 
Neshoba County doctors gave a six o’clock dinner 
with about 25 present. The President of the 
society, Dr. A. L. Majure, acted as toastmaster. 
Dr. Majure is making us a wonderful president. 

J. S. Hickman, 
County Editor. 


SHARKEY COUNTY. 

Miss Ethel Goodman, daughter of Dr. H. S. 
Goodman, Cary, is attending summer school at the 
University of Virginia. 

Drs. H. S. Goodman and W. C. Pool, Cary, 
attended the June medical meeting in Monroe. 

Dr. H. B. Goodman, son of Dr. H. S. Goodman, 
Cary, has just completed his internship at the 
Charity Hospital, New Orleans, and is now on the 
staff of the Charity Hospital, Vicksburg. 

Dr. and Mrs. A. K. Barrier, Rolling Fork, 
visited relatives in Louisiana recently. 

The Sharkey County Health Unit held a pre- 
school clinic at the Cary high school, Cary, June 30, 
where quite a number of children were examined. 
Drs. L. C. Davis, Greenville, Edley H. Jones, 
Vicksburg, and H. S. Goodman and W. C. Pool, 
Cary, gave their services. 

Dr. and Mrs. M. J. Few, Rolling Fork, spent 
July 4th, with relatives in Drew. 

W. C. Pool, 
County Editor. 


Mississippi State Medical Association 


155 


ATTALA COUNTY. 

Dr. Lamar Bailey and Dr. C. A. Pender, 
Kosciusko, attended the Winona District Medical 
Society which convened at Lexington on July 6. 
The meeting and luncheon were enjoyed by all 
present. After the meeting, the Community Hos- 
pital was inspected and found to be modern in 
every detail. Any community is to be congratu- 
lated on securing an institution of this kind. 

The next meeting of the Winona District Medi- 
cal Society will be held at either Europa or 
Kosciusko, about October 1. 

C. A. Pender, 
County Editor. 


Acknowledgment is made of the receipt of a 
post card from Dr. A. G. Payne, Greenville, dated 
July 7, at Rochester, Minnesota. Dr. Payne writes: 
“It does one good to get out and see how other 
people fare, live and do things. Came up through 
Arkansas, Missouri, Iowa, and Minnesota. Crops 
all fine, but depression?.” 


PIKE COUNTY MEDICAL SOCIETY. 

The Pike County Medical Society met at the 
Dew Drop Inn, Summit, July 2, with the follow- 
ing members present: Drs. W. C. Hart, B. J. 

Hewitt, T. W. Hewitt, H. C. Hatcher, G. W. 
Robertson, M. D. Ratcliff, L. J. Rutledge, C. W. 
Stewart, E. M. Givens, L. L. Greer, W. F. Cotton, 
and R. H. Brumfield. 

Visitors present included Drs. T. Paul Haney, 
T. B. Abney, H. K. Butler, D. P. Butler, and I. D. 
Boyett. 

Drs. Haney and Abney were elected to member- 
ship in the society. 

The scientific program included: 

Scraped Apple Treatment of Bloody Diarrheas 
in Infancy — Dr. L. J. Rutledge. 

Prophylaxis in Pregnancy — Dr. E. M. Givens. 

Robert H. Brumfield, Secretary. 


PONTOTOC COUNTY. 

The North East Mississippi Thirteen County 
Medical Society met at Houlka, June 16, with the 
North Mississippi Medical Society as guest. We 
had about 200 doctors present. 

Drs. W. C. Walker and J. M. Hood saw that 
every one present had a good time and we were 
all sorry when the time came to leave. 

The doctors who attended from Pontotoc County 
included: E. G. Abernethy, Algoma; E. B. Burns, 


Ecru; R. P. Donaldson, Pontotoc; A. P. Dunavant, 
Pontotoc; Z. A. Dorsey, Troy, and W. H. Reid, 
Toccopola. 

Dr. O. F. Carr has the sincere sympathy of his 
many friends in the loss of his mother, Mrs. O. C. 
Carr, who died at the ripe old age of 81 on Junt 16. 

A Pontotoc County Vital Statistics Association 
was organized here June 30 on the occasion of the 
visit of Dr. R. N. Whitfield of the Mississippi 
State Board of Health. 

Dr. O. F. Carr and wife, Pontotoc, are vis- 
iting their daughter, Mrs. William May, Jr., at 
Lumbardy. 

The meeting of the staff of the Houston Hos- 
pital, Houston, was held on July 2. 

The subject for discussion, “Bronchography,” 
was presented by Dr. J. R. Williams. All present 
participated in the discussion. These meetings are 
always well attended by doctors from several ad- 
joining counties. They meet twice a month. 

R. P. Donaldson, 

County Editor. 


CHOCTAW COUNTY. 

We have seven physicians in Choctaw County. 
None are boys, still I would not call any of them 
old — not to their faces anyway. All have families 
except two; however, I have seen older men than 
they are assume this responsibility. 

We are badly in need of charity wards in our 
North Mississippi Hospitals and are anxious for 
that time to come. 

J. James Ackerman, 

County Editor. 


MONROE COUNTY. 

June 16 was a memorable day; for on that day 
the Thirteen County Society celebrated “Houlka” 
day according to program announcement. But it 
was stated on the floor by one of the speakers 
that it should have been designated as “Walker” 
day in honor of Dr. W. C. Walker, on whose per- 
sonal invitation the society visited Houlka. 

Houlka is just a small village situated in 
Chickasaw County, built on a spur of the Pon- 
totoc Ridge, but those who have never visited 
Houlka have yet to learn the full meaning of 
hospitality. It seems that Dr. Walker traveled 
to Holly Springs on the day the North Mississippi 
Medical Society held its spring meeting, expressly 
to invite that society to visit with us on June 16. 
This invitation was accepted — so twenty counties 
were in attendance. Besides, the news had been 
passed on that all doctors and their friends would 
be welcome. About 256 doctors were there. 


156 


Mississippi State Medical Association 


The program was good — the day was fine — the 
feast that was spread for us by H.oulka folks sur- 
passed any thing I have ever seen. They had 
prepared for one thousand. The food was de- 
liciously cooked and served. Nothing that could be 
thought of was omitted. 

But as bountiful and fine as the food was, even 
these qualities could not match the welcome and 
hospitality that you sensed as soon as you entered 
the limits of this wonderful little Southern village. 
The best and greatest feature of the occasion was 
the very evident fact that it was the spontaneous 
expression of love and esteem of a splendid people 
for a splendid man. While Dr. Walker is not a 
very old man, he is on the shady slope of life’s 
hill. He has spent his life among these people, 
he has served them well with no thought of his 
own aggrandizement. These people appreciate him, 
they prize him, they love him, both for what he is 
and what he has done for them. Dr. Walker is a 
cultured Southern gentlemen and had he devoted 
his life to letters he might have ranked with the 
best of present day literati. Had he chosen the 
platform he might have held the public spellbound 
with his eloquence; for he is, in the fullest sense, 
an orator. But who would evchange the place 
that he holds in the hearts of his people for the 
passing glory of such triumphs as might have come 
to him had he devoted his time and talents to 
these other lines of endeavor. How fine it would 
be if each of us, when the sunset days shall come, 
might know that we had deserved and served and 
won and kept the ^ove of our people as Dr. Walker 
has the love of the people at Houlka. 

The poet, from whom Dr. Walker quoted on 
that day, in a vein of cynicism, asks the question, 
“What is friendship and what is love?” Let 
another of the old English poets answer, when he 
says, “Love rules the court, the camp, the grove, 
all men below and saints above; for love is heaven 
and heaven is love.” There never was a day like 
“Houlka” day — there may never be another. But 
I am sure, no one who was there will ever regret 
or forget that he was there. 

G. S. Bryan, 
County Editor. 


STILL THEY OCCUR. 

Report of the Bureau of Communicable Diseases 
of the Mississinni State Board of Health shows for 
the month of Mav, tvnhoid fever. 45; smallpox, 
184: diphtheria. 33. All of these could have been 
prevented bv the proper prophylactic immuniza- 
tions. Let’s free Mississippi from these three 
diseases this year. 


HOMOCHITTO VALLEY MEDICAL SOCIETY. 

The third regularly quarterly meeting of the 
Homochitto Valley Medical Society was held at 
Bude, on July 9, with 18 members and two guests 
present. After a most delightful luncheon, the 
meeting was called to order by Dr. Lucien S, 
Gaudet, President, and the following program 
presented: 

1. Report of Dr. J. W. D. Dicks, Councillor, 
8th District. 

2. Report from Vice-President E. E. Benoist, 
Adams County. 

3. Report from Vice-President W. R. Brumfield, 
Amite County. 

4. Report from Vice-President C. E. Mullins, 
Franklin County. 

5. Report from Vice-President R. B. Harper, 
Jefferson County. 

6. Report from Vice-President J. W. Brandon, 
Wilkinson County. 

7. Reports of Delegates who attended the 
Mississippi State Medical Association Meeting for 
1931. 

8. Reports of Committees. 

9. Clinical cases: 

(a) Hematuria Following Traumatic Injury 
Over the Left Kidney Region — Dr. C. A. 
Everette. 

(b) Intestinal Obstruction Caused by a Bolus 
of Round Worms in the Ileum— Dr. C. A. 
Everette. 

10. Paper. ‘‘Some Notes on Gallbladder Dis- 
ease” — Dr. E. E. Benoist. Discussion opened by 
Dr. R. D. Sessions. 

11. Adjournment. 

W. K. Stowers, Secretary. 


CENTRAL MEDICAL SOCIETY. 

The joint meeting of the Central Medical 
Society with the Issaquena-Sharkey-Warren Coun- 
ties Medical Society at Vicksburg on July 14, was 
the last meeting of the Central Medical Society 
before the summer vacation. There will be no 
meeting of the society in August. 

W. L. Hughes, Secretary. 

DR. J. H. RUSH. 

Whereas, an all-wise Providence, the Great 
Physicians of all our humanity, having power to 
heal all sickness and infirmities alike of body and 
soul, but whose ways the finite mind cannot grasp, 


Mississippi State Medical Association 


157 


in His wisdom has removed from the walks of 
men our beloved friend and former co-worker, 
Dr. J. Hack Rush, of Meridian, a successful prac- 
titioner of the dental profession, embracing the 
best years of his wonderful career; a man of un- 
usual skill in dentistry, possessing a dexterity 
later used with telling effect in the broader field 
of surgery; a man of rare charm and magnetism 
of personality, whose face ever mirror and radiated 
the fine soul within, being an humble believer in 
the Fatherhood of God and the Brotherhood of 
man; a man who in the broader field of medicine 
and surgery, thought entering it much later ?n 
life than is the usual order, carved a name and a 
place for himself, impossible to appraise in terms 
of sordid wealth, leaving his kinsfolk, especially 
his two sons, already eminent physicians and sur- 
geons, a heritage more valuable than fine gold or 
monument of stone and marble; a man who com- 
pressed into the forty years of his professional 
career a monumental amount of extraordinary 
service to humanity, and though almost a constant 
sufferer the latter years of his life, smiled to his 
last conscious moments. Therefore, in recognition 
of the above enumerated charming traits of char- 
acter, and his outstanding contributions to the 
dental profession and later to medicine and sur- 
gery. Be it 

Resolved, That the Mississippi Dental Associa- 
tion, in annual assembly in Gulfport, June 4, 1931, 
does hereby take cognizance of the true worth and 
attainments of our departed friend and co-worker, 
pledging ourselves ever to strive to emulate his 
virtues and fine traits of character as well as his 
tireless energy and devoted service to suffering 
humanity. 

Resolved, That the Association do hereby extend 
to his wife, Mrs. Nellie Hunnicutt Rush, to his 
brother, Dr. G. A. Rush, an honored member with 
us, and former partner in dental practice of the 
lamented Dr. J. Hack Rush; to his sons, Drs. 
J. Lowry Rush, and Leslie V. Rush, and other 
relatives, our sincere sympathy and condolence in 
their hour of bereavement. 

Resolved, That a copy of these resolutions be 
conveyed to the above named members of the be- 
reaved family, and that a copy be filed with the 
Department of Archives and History of the Asso- 
ciation. 

Necrology Committee 
Dr. A. B. Kelly, Yazoo City, Miss. 

Dr. A. G. Tillman, Sr., Vicksburg, Miss. 
Dr. L. B. Price, Corinth, Miss. 

Dr. J. F. Brunson, Meridian, Miss. 

Dr. Rush was a graduate dentist and practiced 
dentistry before he studied medicine. 


OLD TRANSACTIONS. 

The Historian of the Mississippi State Medical 
Association has a rather complete set of the trans- 
actions “since the beginning of time.” This col- 
lection is probably the most complete now extant. 
However, the following volumes are missing: 
1874, 1884, 1885, 1886, 1887, 1888, 1889, 1890, 
1892, 1893, 1901. 

It is rather important to the State Association 
that there should be some where at least one com- 
plete set of its transactions. Members of the 
Association are requested to look through their old 
books and if any of the above volumes are found, 
to consider very seriously presenting them to the 
collection of the Historian. Such volumes will be 
well cared for and reference may be made to them 
should any one desire. Your co-operation in this 
is urged. 


COMMITTEES. 

Dr. John C. Culley, President of the Mississippi 
State Medical Association, has announced the 
appointment of the following committees for the 
year : 

Committee on Public Policy and Legislation — 
One year, F. J. Underwood, Jackson; two years, 
Henry Boswell, Sanatorium; three years, W. H. 
Anderson, Booneville. 

Committee on Publication (Ex-Officio) — L. S. 
Lippincott, Vicksburg; J. S. Ullman, Natchez; 
D. W. Jones, Jackson. 

Committee on [Scientific Work — T. M. Dye, 
Clarksdale; Gilruth Darrington, Yazoo City; B. S. 
Guyton, Oxford. 

Committee on Constitution and By-Laws — One 
year, S. W. Johnston, Vicksburg; two years, J. S. 
Ullman, Natchez; three years, W. H. Frizell, 
Brookhaven. 

Committee on Community Hospitals — District 1, 
R. B. Caldwell, Baldwyn; District 2, C. M. Speck, 
New Albany; District 3, E. R. Nobles, Rosedale; 
District 4, V. B. Philpot, Houston; District 5, 
M. L. Flynt, Newton; District 6, J. P. Culpepper, 
Hattiesburg; Distict 7, J. W. D. Dicks, Natchez; 
District 8, R. W. Smith, Canton. 

Chairmen of Sections. 

The President has appointed the following 
Chairmen of Sections: iSurgery, W. H. Anderson, 

Booneville; Medicine, G. W. F. Rembert, Jackson; 
Eye, Ear, Nose and Throat, Edley H. Jones, Vicks- 
burg; Hygiene and Public Health, F. M. Smith, 
Vicksburg; Radiology, George E. Adkins, Jackson. 


JOINT MEETING. 

Fifty-eight members and guests attended the 
joint meeting of the Central Medical Society and 
the Issaquena-Sharkey-Warren Counties Medical 


158 


Mississippi State Medical Association 


Society held at the Vicksburg Country Club on 
June 14. After a short address of welcome by 
President J. B. Benton of the Issaquena-Sharkey- 
Warren Counties iSociety, the following scientific 
program by the members of the Central Medical 
Society was presented: 

1. Acute Osteomyelitis— Dr. J. W. Barksdale, 
Jackson. 

Discussed by Drs. 0. H. Swayze, Yazoo City; 
S. H. McLean, Jackson; Julius Crisler, Jack- 
son; John Darrington, Yazoo City; W. H. 
Parsons, Vicksburg, and G. M. Street, 
Vicksburg. Dr. Barksdale closed. 

2. The Use of Spinal Anesthesia in Obstetrics — 
Dr. L. W. Long, Jackson. 

Discussed by Drs. Joe Roberts, Thornton; 
G. M. Street, Vicksburg; J. W. Barksdale, 
Jackson; John Darrington, Yazoo City; Gil- 
ruth Darrington, Yazoo City; I. C. Knox, 
Vicksburg; S. H. McLean, Jackson; P. iS. 
Herring, Vicksburg, and E. F. Howard, 
Vicksburg. Dr. Long closed. 

3. The Incidence of Malignancy — Dr. A. G. 
Wilde, Jackson. 

Discussed by Drs. Julius Crisler, Jackson; 
A. Street, Vicksburg; G. M. Street, Vicks- 
burg. Dr. Wilde closed. 

Dr. E. F. Howard, Vicksburg, offered the follow- 
ing resolution: 

Be it resolved, That the President appoint a 
committee of three — one from each of the coun- 
ties composing this society— to investigate the 
activities of all agencies practicing medicine in the 
three counties, Issaquena, Sharkey, and Warren, 
that are financed either in whole or in part from 
the public funds ; in an effort to determine if, and 
to what extent, these activities are infringing on 
the rights and just privileges of private physi- 
cians; and 

Be it further resolved, That this committee be 
instructed to report its findings, together with 
such recommendations as it may choose to make, 
too the next meeting of this society. 

E. F. Howard, 

S. W. Johnston, 

Leon S. Lippincott, 

W. H. Parsons, 

Edley H. Jones, 

B. B. Martin. 

After explanation of this resolution, on motion 
Dr. Howard, seconded by Dr. Jones, it was 
unanimously adopted. The President appointed as 
the committee Drs. W. H. Parsons, Vicksburg, for 
Warren County; W. C. Pool, Cary, for Sharkey 


County, and J. B. Benton, Valley Park, for Issa- 
quena County. 

At the conclusion of the meeting the ladies of 
the Women’s Auxiliary of the IssaquenaiSharkey- 
Warren Counties Medical Society served a plate 
lunch on the lawn of the Country Club. 

DEATHS OF MISSISSIPPI DOCTORS. 

Dr. iS. A. Scruggs, Lauderdale County; sudden 
death; June 4, 1931, at Lauderdale. Born 1854. 

Dr. C. L. Bufkin, Columbia; Pellagra; at Colum- 
bia. Born at Columbia. 

Dr. Louis D. Dickerson, McComb; Appendicitis 
followed by gas bacillus infection; June 4, 1931, 
at McComb. Born in Simpson County, Septem- 
ber 11, 1869. 

Dr. James Cox Vandiver, Baldwyn; Operation 
for gallstones; June 9, 1931, Booneville. Born at 
Baldwyn, May 23, 1883. 

Dr. V. W. Maxwell, Gulfport; General periton- 
itis following appendectomy; June 26, 1931, at 
Gulfport. Born Mississippi, 1891. 

Dr. William Little Davis, Walls; Myocarditis and 
muscular rheumatism; May 4, 1931, at Walls; 
age 74. 

Dr. D. R. Lamb, Artesia; Heart attack; May 
25, 1931, at Artesia. Born at Europa, May 10, 
1880. 

Dr. R. L. Anderson, Inverness, May 31, 1931, at 
Inverness. Born at West, Holmes County, August 
29, 1875. 


DOCTOR LUTHER LEE GREER. 

Dr. Luther Lee Greer, age 50, McComb, died 
July 11, after a brief illness following an operation 
for appendicitis. 

Dr. Greer had resided in McComb for a number 
of years and enjoyed a large practice. He is sur- 
vived by his wife, one son, Luther Lee, Jr., and 
one daughter, Miss Mildred Greer of McComb, a 
brother John Greer, and a sister Mrs. C. T. 
Brewer of McComb. 


Dr. Hardie Hays, Jackson, colonel, medical 
reserve corps, United States army, recently spent 
two weeks at Fort Beauregard, Louisiana, as camp 
physician of the C. M. T. C. Dr. Hays was chief 
of the medical staff of the civilian training camp. 

MISSISSIPPI STATE BOARD OF HEALTH. 

On July 1, the Pike County Health Department 
was organized with Dr. T. Paul Haney, Jr., as 
Director. Dr. Haney will have associated with 
him Miss Inez Driskell, Supervising Nurse; Miss 
Marjorie Patterson, Public Health Nurse; Miss 
Elizabeth Kimmons, Dental Hygienist; Miss Mar- 


Mississippi State Medical Association 


159 


h Irwin, Secretary; and L. W. Murphy, Engineer- 
, jliector. Pike is one of the counties chosen by 
1 Commonwealth Fund for financial co-operation 
i giving to the citizens “super” health service, 
ir. T. Paul Haney, Jr. and Dr. B. D. Black- 
er have just returned from Johns Hopkins 
L versity where they attended the School of 
: >'iene and Public Health and were awarded cer- 
; :ates in public health. 

)r. J. A. Milne has just completed a course in 
Egiene and Public Health at Harvard University 
iibre he was awarded the degree of Master of 
jblic Health. Dr. Milne is now Director of the 
f Id Unit of the Mississippi State Board of Health, 
tecent visitors to the Mississippi iState Board 
( Health: Miss Miriam Birdseye, U. S. Extension 
jipartment, Washington, D. C. ; Dr. James R. Mc- 
Ijrd, Emory University, Atlanta, Georgia; Mrs. 
j liter McNab Miller, American Child Health 
Jsociation, New York City; Arthur J. Strawson, 
bid Secretary, National Tuberculosis Associa- 
in, New York City; Dr. M. Flint Haralson, Chief 
uarantine Officer, The Panama Canal; Dr. and 
I’s. Earl Bates, U. S. Bureau of Indian Affairs, 
ashington, D. C. ; Dr. J. W. Cox, American 
ciety for Control of Cancer, New York, N. Y. ; 
\ R. A. Vanderlehr, Passed Assistant Surgeon, 
kited States Health Service, Washington, D. C.; 
]:. 0. C. Wenger, Surgeon, United States Public 
kalth Service, Washington, D. C. ; Dr. L. L. Lums- 
|h, Medical Officer, United States Public Health 
irvice, Washington, D. C.; Dr. C. A. Scamman, 
he Commonwealth Fund, New York City; Dr. 
jester J. Evans, The Commonwealth Fund, New 
prk City; Miss Theresa Kraker, The Common- 
wealth Fund, New York City; Dr. H. N. Cruchley, 
ockefeller Foundation Fellow, Jamaica; Miss 
Margaret E. Dizney, Nursing Field Representa- 
;ve, American Red Cross, Washington, D. C.; 
ialph Earl, Earl Engineering Company, New 
rleans, Lo. ; Leon Lasser, Civil Engineer, New 
Cleans, La.; Dr. Julius Moldovan, Institute 
f Hygiene, Roumania; Dr. Leon Prodan, Institute 
f Hygiene, Roumania; Dr. A. J. Warren, New 
r ork City; Mrs. R. D. Rood, Staff Associate, White 
louse Conference on Child Health and Protection; 
. Georzandjis, Athens, Greece; Dr. H. C. Barnard, 
Hrector, White House Conference on Child 
lealth and Protection, Washington, D. C.; D. T. 
leorgradis, Athens, Greece; Dr. Robert A. Strong, 
'ulane University, New Orleans, Louisiana; T. T. 
lolokotronis, Athens, Greece. 


HONOR ROLL. 

J. C. Culley, T. M. Dye, D. W. Jones, E. F. 
loward, F. J. Underwood, A. G. Payne, C. M. 
Speck, J. S. Hickman, W. C. Pool, C. A. Pender, 
t. P. Donaldson, J. J. Ackerman, E. B. Bruns, G. 
!. Bryan, C. M. Coker, W. H. Curry, W. N. Jankins, 


M. L. Montgomery, A. P. Durfey, T. J. Brown, 
E. H. Jones, L. J. Rutledge, G. H. Wood, A. H. 
Little, R. H. Brumfield, T. L. Bennett, J. M. Acker, 
W. K. Stowers, W. L. Hughes. 

The above were contributors to the August num- 
ber of the Mississippi News Section. THANK 
YOU! 


COUNTY EDITORS APPARENTLY ON 
VACATION. 

L. Wallin, Adams; J. R. Hill, Alcorn; P. Jack- 
son, Amite; F. Ferrell, Benton; J. A. Hardin, Cal- 
houn; J. P. T. Stephens, Carroll; W. C. Walker, 
Chickasaw; S. R. Deanes, Clay; W. L. Little, 
Copiah; A. V. Richmond, DeSoto; C. E. Mullins, 
Franklin; C. M. Shipp, Hancock; C. McCall, Harri- 
son; A. G. Wilde, Hinds; R. C. Elmore, Holmes; 
W. H. Scudder, Issaquena; N. W. Nunnery, Ita- 
wamba; B. S. Mcllwain, Jackson; R. B. Harper, 
Jefferson; F. E. Linder, Lafayette; C. T. Burt, 
Lauderdale; B. S. Waller, Lawrence; A. J. Stacy, 
Lee; W. H. Frizell, Lincoln; J. W. Lipscomb, 
Lowndes; D. R. Moore, Marshall; S. S. Caruthers, 
Montgomery; S. A. Majure, Newton; J. D. Green, 
Nuxubee; H. L. Scales, Oktibbeha; R. B. Cunning- 
ham, Prentiss; H. N. Holyfield, Rankin; W. C. 
Anderson, Scott; S. E. Dunlap, Stone; W. D. 
Smith, Tate; C. M. Murry, Tippah; H. P. Boswell, 
Union; B. L. Crawford, Walthall; S. E. Field, Wil- 
kinson; G. A. Brown, Yalobusha. 

It is a fine thing to be able to take a vacation 
this year. Congratulations! 

While you are enjoying yourselves, think of 
your editors in their offices toiling to give you a 
real Journal. 


SOCIETIES ALSO APPARENTLY ON 
VACATION. 

At least no news! Claiborne, Clarke-Wayne, 
Clarksdale and Six Counties, Delta, DeSota, Har- 
rison-Stone-Hancock, Jackson, Kemper, Leake, 
South Mississippi, Tate County, Tri-County, Win- 
ona District. 

HOW DO YOU LIKE OUR CALENDAR? 

Dates of coming meetings reported — NONE! 


NO COUNTY EDITORS. 

The following counties have no editors thus far. 
WHY? Bolivar, Clark, Coahoma, Covington, For- 
est, George, Greene, Humphrey, Jasper, Jefferson 
Davis, Jones, Kemper, Lamar, Leake, Leflore, 
Marion, Pearl River, Perry, Quitman, Simpson, 
Smith, Sunflower, Tallahatchie, Tunica, Washing- 
ton, Wayne. 

Your President or your Secretary, or both, have 
been asked to make appointments to the Board 
of County Editors. Will you not ask their co- 
operation? 


BOOK REVIEWS 


Manual of Surgery: By Frances T. Stewart, 

M. D., and Walter Estell Lee, M. D. 6th ed. rev. 
Philadelphia, P. Blakiston’s Son & Company. 
1931. pp. 1307. 

This new sixth edition admirably meets the 
requirements of the undergraduate for whom the 
original edition was prepared by Frances T. 
(Stewart. It also meets the demand of the busy 
practitioner for whom it makes available a great 
fund of information concisely put. 

Dr. Walter Estell Lee has added many new 
chapters which have increased the value of the 
book. 

The subject of anesthesia and anesthetics has 
been brought up to date to include ethylene, sodium 
amytal and avertin. 

The authors have done well to include the chap- 
ter on bandaging which they have borrowed from 
Wharton’s Minor Surgery. 

Recent developments in surgery of the heart and 
pericardium are discussed in a chapter which was 
prepared by Dr. Elliott Cutler. 

The chapter on post-operative treatment is par- 
ticularly valuable. 

Attention is directed to the management of 
punctured wounds in the prevention of tetanus 
which should be more generally caried out. 

The chapters on abdominal surgery are well 
illustrated, and are extremely interesting as well 
as valuable. 

On the whole the book should occupy an im- 
portant place in the library of the busy surgeon 
who is anxious for a ready-reference volume. 

Isidore Cohn, M. D. 


How It Happened: By A. G. Bettman, M. D., 

F. A. C. S. Philadelphia, F. A. Davis Co. 
1931. pp. 110. 

If there is a prize for unadulterated nerve it 
should be awarded to Dr. Bettman (whose first 
name is incidentally Adalbert). After reading his 
collection of Sandburgesque “pomes” anent medi- 
cine, one wonders if the young poet-doctor enjoyed 
writing them half as much as finding a publisher 
brave enough to print them. No doubt the studio 
sophisticates and drawing-room literati will defend 
“How It Happened” and label it Smart; other will 
dismiss the book as dribble. Subtly humorous or 
silly, it is a novel and unique departure. 

Maurice Sullivan, M. D. 


Treatment of Epilepsy : By Fritz B. Talbot, M. D. ; 

New York, Macmillan Company. 1930. pp. 308. j ! 

This is a monograph on a very important sub- 
ject and there is at present great need for a book : 
of this character. 

In the preface the author informs us that this ji 
book is intended to present the facts which seem j 
essential for an understanding of the disease from > 
the point of view of the general practitioner, and j 
to outline the practical methods of treatment. To j 
the reviewer he has more than carried out his ( 
intentions. 

The title of this excellent monograph would lead | 
one to believe that it treats only of the treatment | 
of epilepsy, but the author has judged wisely to : 
include in the first part of the book in a complete, 
clear and brief manner short chapters dealing with 
the history and age incidence of the disease proving 
with statistical tables from the best available 
sources the importance of the recognition of the 
existence of the disease in early life when treat- 
ment is most apt to prove beneficial. Then follows 
the chapter on etiology. Here the latest views on 
the various etiological factors are discussed, in- 
cluding the intoxications, dysfunctions of the en- 
docrine glands and, of great importance, at this 
time, the intimate relation between the metabolic 
processes of the body and the symptom complex 
known as epilepsy. In the chapter on pathology 
will be found the role played by intracranial pres- 
sure and the theory upon which the dehydration 
method of treatment is based. Equally interesting 
will be found the chapters on diagnosis, prognosis 
(especially under various form of treatment) and 
symptoms, including in the latter the epileptic 
equivalents and the atypical attacks. At the end 
of the first section will be found chapters on the 
treatment of the epileptic, including the treatment 
of the seizure, the removal of the probable causes 
by the reduction of the disturbing factors, the 
proper attention which should be given to physical, 
social and mental hygiene, education, diet and 
drugs. 

In the second section of the monograph, cover- 
ing more than half of the work, the author presents 
the subject of dietary treatment. He enters very 
minutely but clearly into the description of the 
factors necessary for an understanding of the 
dietary treatment, the general theoretical factors 
involved in ketosis, the clinical results of fasting, 
the clinical results of the ketogenic diet, the de- 
tailed management of the ketogenic diet with the 
methods of producing ketosis. All of this from 


Book Reviews 


161 


one who is known for his excellent research on 
the metabolism of epilepsy. 

The reviewer finds its difficult in this short re- 
view to call attention to more valuable points in 
this hook. Suffice it to say, that from the stand- 
point of actual practice it is invaluable and should 
be consulted by all those who treat epileptics. 

L. L. Cazenavette, M. D. 
— 

Diagnostic Methods in Internal Medicine: By 

Samuel A. Lowenberg, M. D., F. A. C. P. 
2nd. rev. ed. Philadelphia, F. A. Davis Co. 
pp. 1032. 

The popularity of this treatise on diagnostic 
| methods is attested by the exhaustion of two large 
| printings of the first edition and now the publica- 
tion of this second edition after a period of two 
years. The book is profusely illustrated by some 
547 good illustrations and charts. It is more than 
a work on physical diagnosis for it contains some 
one hundred pages on the interpretation of labora- 
tory findings. This is a valuable addition. The 
reviewer believes that this volume is one of the 
most complete on this subject and can be recom- 
mended to both students and practitioners. 

Randolph Lyons, M. D. 


Heart Disease: By Paul Dudley White, M. D. 

New York, The Macmillan Company, 1931. 

pp. 931. 

Dr. White’s monograph is the most important 
contribution to recent literature in this field. It 
covers adequately all of the modern conceptions 
of heart disease and all that is latest in diag- 
nosis and treatment. ■ Hence, it can be regarded 
as authoritative. Dr. White’s selection of what 
is to be presented and what is to be emphasized 
shows, the sound judgment of the ripe clinical 
observer and experienced teacher. It is a book 
whose easy style tempts one to read from cover 
to cover, and to whose pages one will acquire the 
habit of referring when seeking aid. It is of such 
monographs that the doctor may build up a library 
dependable and helpful, a collection of good friends, 
as it were. The constant allusion to the history 
of the development of our knowledge of heart 
disease adds greatly to the interest and value of 
the text ; particularly stimulating is the inclusion 
from time to time of extensive quotations from 
epoch-making contributions by past masters. Such, 
for example, are quotations from Laennec’s and 
Auenbrugger’s original communications on percus- 
sion and auscultation respectively, Heberden’s de- 
scription of angina pectoris, and Stokes’ and 
Adams’ first report of heart block. The extensive 


and very complete bibliography adds additionally 
to the value of the work. 

I. I. Lemann, M. D. 


Diabetes: Its Treatment by Insulin and Diet: 

A Handbook for the Patient. By Orlando H. 
Petty, A. M., M. D., F. A. C. P. 5th ed. rev. 
Philadelphia, F. A. Davis Company. 1931. 
pp. 231. 

A good, clear, dependable guide for the diabetic 
patient. The appearance of its fifth edition is an 
indication of its apparent popularity. There are 
a number of these handbooks for diabetic patients 
by various authors. Most of them are about equal 
in merit. They constitute a very important factor 
in the education of the diabetic patient and in his 
proper treatment. Every doctor treating diabetic 
patients should familiarize himself with some of 
these guides and select one which he can recom- 
mend and prescribe for his patients. 

I. I. Lemann, M. D. 


The Treatment of Chronic Deafness by the Electro- 
phonoide Method of Zund-Burguet: By 

George C. Cathcart, M. A., M. D. 2nd ed. 
Lond., Oxford University Press. 1931. pp. 126. 

Chronic deafness of such frequent occurrence 
is such a depressing physical handicap to its vic- 
tims that any method of treatment offering a ray 
of hope for its alleviation should be thoughtfully 
considered. It is a debatable question whether 
marked deafness is more depressing mentally to 
the sufferer than blindness but every otologist has 
his share of deaf persons with head noises who 
speak of contemplating suicide. 

The Zund-Burguet electrophone was devised by 
Dr. Zund-Burguet, of Paris, who is not a phy- 
sician, but a physicist. He originally intended his 
instrument to be an aid in the re-education of the 
deaf and dumb. Later it was used as a re- 
educative method of treating deafness by means of 
auditory exercises ;wa's used as long ago as the 
first century A. D., and has been revived and used 
at various times since then. Auditory exercises 
are today used in selected cases in the training of 
speech for the deaf and dumb, being used to give 
the pupil the sense of pitch without which he never 
develops a properly modulated voice. 

The electrophone of Zund-Burguet reproduces 
the sound vibrations of the whole gamut of the 
human voice and is thus intended to give requisite 
physiological stimulus to the ear. It produces 
pitches of sounds ranging from 80 to 3500 dvs., 
these being the frequencies of practical importance 
to the human ear. Volume may be regulated at 
will. In addition to sound, the apparatus, by 


162 


Book Reviews 


means of a secondary current imposed on the prim- 
ary one, produces what Cathcart calls “molecular 
massage” which is felt as a gentle tickling in the 
ear and tends to relieve the sense of fullness in 
the head complained of by most deaf people. The 
author gives detailed instructions for operation 
of the electrophone with numerous exercises for 
treatment of the deaf. 

The author gives his results from the treatment 
of 665 cases of deafness by this method. Of 187 
cases of nerve deafness 138 or 73.8 per cent im- 
proved. Of 261 cases of chronic otitis media (not 
classified into suppurative and non-suppurative) 
174 or 66.6 per cent improved. Of 217 cases of 
otosclerosis, 117 or 53.9 per cent improved. Taken 
as a whole 64.5 per cent of 665 cases of chronic 
progressive deafness were improved. 

H. Kearney, M. D. 


Crippled Children; Their Treatment and Ortho- 
pedic Nursing: By Earl D. McBride, B. S., 

M. D., F. A. C. S. St. Louis, C. V. Mosby Co. 

pp. 280. 

This book will be of great help to nurses, edu- 
cators and all who are interested and have under 
their supervision the care of crippled children. It 
is a very readable book and should appeal strongly 
to internes and nurses. 

There are chapters on the use of plaster paris, 
adhesive plaster, orthopedic equipment and physi- 
cal therapy. The various crippling diseases are 
explained and their treatment outlined. There is 
an appendix giving definition of orthopedic terms 
which will readily be appreciated. 

The author is a personal friend of your reviewer 
and I can speak for his painstaking care in the 
treatment of crippled children. 

Edward S. Hatch, M. D. 


Handbook of Physiology : By W. D. Halliburton, 

M. D„ LL. D., F. R. C. P., F. R. S. and R. 
J. S. McDowall, M. B., D. SC., F. R. C. P. 
(Edin.). 19th ed. Philadelphia, P. Blakiston’s 
Son and Co. 1930. pp. 842. 

During fifty-four years this book, known as 
Kirkes’ Physiology, saw thirteen editions in suc- 
cession edited by a number of physiologists all of 
whom were connected with St. Bartholomew’s Hos- 
pital. In 1896 Professor Halliburton took over the 
work incident to bringing out a new edition. In 
twenty-nine years under Professor Halliburton’s 
guidance, seventeen editions were published, so, 
as the book had become an entirely new one, the 
name of Kirkes was dropped, and Halliburton's 
Physiology became its recognized title. In 1928 an- 
other revision became necessary; and as Professor 


Halliburton found that he needed help in preparing 
it, the assistance of his successor at King’s Col- 
lege, Professor McDowall, was secured. 

Although the authors in their preface point out 
that in holding with the advances in Physiology, j 
which make it no longer necessary to write a text- 
book of Physiology on an anatomical basis, they ' 
have omitted much of the detail of histology which J 
earlier editions carried, the reviewer is convinced 
that there are still far too many illustrations of 
gross and microscopic anatomy. The first four i 
chapters might have easily been omitted and there 
is too much chemistry for a book dealing with 
Physiology in the usual meaning of the word. The j 
subject matter is handled too briefly to be adequate. 1 
This is notably so in the case of the electrocardio- j 
gram and the glands of internal secretion. 

Henry Laurens, Ph. D. | 


Diet Book for Doctor, Patient and Housewife : 
By Marguerite Requa Rae. London, Oxford 
Univ. Pres. 1931. pp. 197. 

It merits no particular considerations. 

I. L. Robbins, M. D. J 


PUBLICATIONS RECEIVED. 

P. Blakiston’s Son & Co., Philadelphia: The j 

Doctor and His Investments, by Merryle Stanley I 
Rukeyser, B. Lit., M. A. Recent Advances in Medi- 
cine, by G. E. Beaumont, M. A., D. M. (Oxon), 
F. R. C. P., D. P. H. (Lond.), and E. G. Dodds, 
M. V. 0., M. D., Ph. D., B. Sc. Recent Advances 
in Pulmonary Tuberculosis, by L. S. T. Burrell, 
M. A., M. D., F. R. C. P. (Lond.). 

Oxford University Press, New York: Infuries 

and Sport, A General Guide for the Practitioner, 
by C. B. Heald, C. B. E., M. A., M. D., M. R. C. P. 
(Lond.) . 

W. B. iSaunders Company, Philadelphia: Col- 

lected Papers of The Mayo Clinic and the Mayo 
Foundation, by Mrs. Maud H. Mellish-Wilson, Rich- 
ard M. Hewitt, B. A., M. A., M. D„ and Mildred 
A. Felker, B. S. Proctoscopic Examination and 
the Treatment of Hemorrhoids and Anal pruritus, 
by Louis A. Buie, B. A., M. D., F. A. C. S. A 
Text-Book of Medical Diseases for Nurses, by 
Arthur A. Stevens, A. M., M. D., and Florence 
Anna Ambler, B. S., R. N. A Clinical Study of j 
Addison’s Disease, by Leonard G. Rowntree, M. D., 
and Albert M. Snell, M. D. 

Lea & Febiger, Philadelphia: Accidental In- 

juries, by Henry H. Kessler, A. B., M. D., F. A. C. 
S., F. A. P. H. A. 

Williams & Wilkins Co., Baltimore: Interna- 

tional Studies on the Relation Between the Private 
and Official Practice of Medicine with Special Ref- 
erence to the Prevention of Disease, by Sir Arthur 
Newsholme, K. C. B., M. D., F. R. C. P. 


New Orleans Medical 

and 

Surgical Journal 

Vol. 84 SEPTEMBER, 1931 No. 3 


THE BURDEN OF SYPHILIS 
AND GONORRHEA IN 
NEW ORLEANS.*! 

WALTER CLARKE, M. A., M. B., L. R. C. P. 

(Edin.)t 

New York. 

Until recently statistics as to the preval- 
ence of syphilis and gonorrhea in Ameri- 
can communities were almost entirely 
lacking. Although many States require 
the reporting by physicians of cases of 
syphilis and gonorrhea which come under 
their care, it is a well known fact that 
many physicians do not report their cases, 
and it is only gradually that this phase 
of health work is improving. A proced- 
ure developed in Europe, was first used in 
the United States in 1926 by the American 
Social Hygiene Association, and later 
adopted by the United States Public Health 
Service, for learning the number of cases 
of syphilis and gonorrhea, by stage of 
disease, by color, and sex, actually under 
treatment in private practice and in pub- 
lic institutions on a given day. It was 

*Part I of the New Orleans Social Hygiene 
Survey made by the American Hygiene Association 
with the co-operation of the U. S. Public Health 
Service, under the auspices of the New Orleans 
Central Council of iSoeial Agencies. Read before 
the Orleans Parish Medical Society, April 27, 
1931. 

fCertain sections of this report were prepared 
by a representative of the U. S. Public Health 
Service and are published by permission of the 
Surgeon General. 

fAssociate General Director of the American 
Social Hygiene Association. 


recognized that this revealed only a mini- 
mum number of cases in a given com- 
munity, as a large number of individuals 
suffering from syphilis and gonorrhea 
who seek treatment from druggists and 
from quacks, and in addition those who 
entirely neglect to secure medical aid, can- 
not be included in these prevalence studies. 
From May, 1925, to February, 1929, 
twenty-five large and small communities 
in various parts of the United States had 
been surveyed by this method, and the 
population of the areas surveyed was 
24,498,000, which constitute about 20 per 
cent of the total population in the United 
States. The average number of cases of 
syphilis and gonorrhea actually under 
treatment in the United States at a given 
time, according to these surveys, was 7.46 
per thousand. 

With the co-operation of the United 
States Public Health Service this method 
of investigation was applied in the course 
of the New Orleans Social Hygiene Survey. 
Very valuable assistance was given by the 
Orleans Parish Medical Society, and the 
success of our investigation into the num- 
ber of cases actually under treatment in 
New Orleans on a given day, namely, Feb- 
ruary 2, 1931, is due in a very large degree 
to the co-operation of this Society, in view 
of the fact that without the assistance and 
good will of the individual physician it 
would not have been possible to collect the 
necessary data. The efficiency of the 
method is indicated by the fact that 99 
per cent of the physicians in practice in 


164 


Clarke — The Burden of Syphilis and Gonorrhea in New Orleans 


i 




New Orleans responded to the question- 
naire with the information desired.* 

According to the results of this census 
of cases, there were on February 2, 1931, 
4,820 cases of syphilis and gonorrhea 
under treatment by private practitioners 
or in public institutions, including the hos- 
pitals, prisons, and eleemosynary institu- 
tions. This equals a rate of 12.45 per thou- 
sand which is among the highest obtained 
in any of the surveys made by the United 
States Public Health Service and the 
American Social Hygiene Association. 
Average venereal disease rates in a num- 
ber of individual cities over 100,000 in size 
also with large colored population, may be 
compared with New Orleans, as follows : 
Norfolk, Virginia, 6.8 per thousand; Knox- 
ville, Tennessee, 9.2; Richmond, Virginia, 
9.5; St. Louis, Missouri, 15.8; Memphis, 
Tennessee, 19.9. 

The number of cases of syphilis under 
treatment in New Orleans was 2,676, a 
rate of 6.9 per thousand. The average 
rate for syphilis found in the twelve 
studies previously mentioned was 4.1 per 
thousand. The rate per thousand for gon- 
orrhea in New Orleans was 5.5, there be- 
ing 2,144 cases reported under treatment. 
This again compares with the average rate 
of 3.4 per thousand in the group of studies. 

Both white and colored patients show 
higher than average rates in New Orleans. 
The previous average for white patients 
was 7.9 per thousand, while in New Or- 
leans it was 9.9 per thousand. The pre- 
vious average rate for colored patients 
was 11.0 per thousand, while in New Or- 
leans it was 19.7 per thousand. On analy- 
sis it appears that the great difference in 
rate per thousand between colored and 
white people in New Orleans is to be found 
in those suffering from syphilis. Thus the 
rate for colored males for syphilis is 16.8 

*A detailed report of this census of cases will be 
published in due course by the United States Public 
Health Service. Only a preliminary summary can 
be given here. 


as compared with 6.6 for white males. 
These rates for males under treatment are 
parallel though at a somewhat smaller 
figure to the rates for females under treat- 
ment for syphilis, 11.6 as compared with 
2.2 per thousand white females. 

Rates for gonorrhea by race are more 
uniform. The rate for colored males with 
gonorrhea is 9.6 per thousand and for 
white males, 8.3. For females, the rates 
are similar, being 2.2 for colored females, 
and 2.8 for white. Thus it appears that 
there are actually more white females 
under treatment for gonorrhea than col- 
ored females. These facts are well illus- 
trated in Figure 1. This shows that in 

SYPHILIS GONORRHEA 


Wale Male 



Fig. 1. Syphilis and gonorrhea rate per 100 population 
und;r treatment on Feb. 2, 1931, separated by s;x and color. 




Clarke — The Burden of Syphilis and Gonorrhea in New Orleans 


165 


New Orleans there are per thousand pop- 
ulation more than twice as many colored 
males, and five times as many colored 
females under treatment for syphilis as 
there are white males and females. This, 
it should be borne in mind, includes not 
only patients who are attending clinics, 
but also those who are treated in private 
practice. It may be pointed out, however, 
that this is not a unique situation and that 
a similar state of affairs has been found 
in many other surveys. The high preval- 
ence rate among the colored part of the 
population has been brought out with great 
emphasis in the course of a Wassermann 


syphilis, the rate per thousand is 41 for 
colored males as compared with 20 for 
white males. The reverse of these rates 
is true for gonorrhea in the male, being 
22 per thousand for colored as compared 
with 42 per thousand for white males. 
The colored female syphilis rate is 8 per 
thousand as compared with the rate for 
white females of 4.9, while the rate for 
gonorrhea in the colored female is 10.9 as 
compared with 13.3 for white females. 

Estimates based upon these incidence 
rates give the following results (Table 1) 
as to the number of cases to be expected 
in the course of one year: 


1,342 6,957 


TABLE 1. ESTIMATED ANNUAL ATTACK RATE 


Male 


Rate 

Syphilis 

White 20 

Colored 41 

Total 

Gonorrhea 

White ■ 42 

Colored 22 

Total H 


Estimated 
No. of Cases 

3,360 

2,255 

5,615 

7,056 

1,210 

8,266 


Rate 


4.9 

8.0 


13.3 

10.9 


Female 

Estimated 
No. of Cases 

838 

504 


2,274 

687 


Total 


2,961 


11,227 


Grand Total 18,18*; 


survey of negroes on the cotton plantation 
of Mississippi where routine Wassermanns 
of 2,300 negroes over one year of age 
revealed 24 per cent positive. Studies 
conducted by prenatal clinics which in- 
clude a routine Wassermann on all preg- 
nant women who attend, bear out similar 
facts. Dr. J. R. McCord in his clinic in 
Atlanta found 23 per cent positive among 
the colored patients attending the clinic. 
All the evidence therefore would seem to 
point to a greater prevalence of syphilis 
among Negroes than among white people 
and this is evidently as true in New Orleans 
as it is elsewhere. 

The annual incidence rate based upon 
the findings in the same one-day census 
in New Orleans during the period of Janu- 
ary, 1931, gives the following results: For 


It has been estimated by the New York 
State Health Department that it costs $200 
to treat adequately one case of syphilis, 
and $60 to treat adequately one case of 
gonorrhea. Assuming that the cost of 
treatment of these cases would be much 
less in New Orleans than in New York 
State, we may estimate $100 as the cost 
for a case of syphilis and $30 for a case 
of gonorrhea adequately treated in New 
Orleans. This, according to the incidence 
figures given above, would give the appall- 
ing sum of $1,033,510 for the treatment of 
new infections alone of syphilis and gon- 
orrhea in New Orleans in the course of 
one year. This does not take into account 
cases of longer duration still under treat- 
ment from past years, nor does this figure 
given in money values consider the physi- 
cal suffering, the pain brought to the fami- 


166 


Clarke — The Burden of Syphilis and Gonorrhea in New Orleans 


lies of the infected, the loss of time at 
labor, nor the final mortality rate, especi- 
ally from syphilis. 

Regarding the 4,820 cases of syphilis 
and gonorrhea under treatment on a given 
day, February 2, in New Orleans, it is 
important to inquire where they were 
treated and by whom. The returns of the 
prevalence study indicate that fifty-two 
per cent of the cases of syphilis and thirty- 
seven per cent of the cases of gonorrhea 
were under treatment in public clinics. 
When, however, these patients were sep- 
arated by race, it is found that a far larger 
number of colored patients than white 
patients are under treatment in public 
clinics. The figures are as follows: Col- 
ored syphilis patients treated at public 
expense, 1,219 or 86 per cent — colored gon- 
orrhea patients, 357 or 63 per cent; white 
syphilis patients, 450 or 36 per cent — white 
gonorrhea patients, 408 or 26 per cent. 

Assuming that the prevalence rates dis- 
covered in the course of the present study 
are reasonably correct, it is of interest to 
compare the number of newly treated cases 
of syphilis and gonorrhea occurring in 
New Orleans in the course of one year, 
with those reported under the law to the 
city and state health authorities. During 
the fiscal year ending 1930, there were 


STPaiLIS GOIfORftHEA 



Fig. 2. New Orleans Venereal Diseasee Cases reported 
to State Health Department compared to data collected in 
prevalence study. 


under treatment in New Orleans, 2,144 
cases of gonorrhea. Figure 2 illustrates 
this comparison. It will be seen, therefore, 
how comparatively few cases are reported 
in accordance with the terms of the law 
by institutions and physicians in New Or- 
leans. The following figures give an indi- 
cation of reports during other years : 


TABLE 2. CASES REPORTED TO STATE BOARD OF HEALTH 

1928 1929 1930 

Number of Cases of Syphilis 4,163 2 767 2 437 

Number of Cases of Gonorrhea 2,224 1,202 1 273 


reported to the State Board of Health, 
2,436 cases of syphilis of which 2,146 were 
from New Orleans. Our prevalence study 
indicates that on one given day there were 
more cases of syphilis under treatment in 
New Orleans than were reported in the 
course of one whole year to the city health 
department, namely, 2,676 cases. During 
the year 1930 there were reported to the 
State Board of Health, 1,273 case of gon- 
orrhea, of which 973 were from New Or- 
leans ; while there were on one given day 


These figures indicate a substantial re- 
duction in the number of cases reported 
during recent years. This reduction is 
shown not only in figures for the State as 
a whole, but also for the City of New Or- 
leans. It is suggested that the city and 
state health authorities should inquire into 
this decrease in reporting of syphilis and 
gonorrhea. There is no reason to suppose, 
so far as we have been able to discover, 
that there has been a decrease in the num- 
ber of cases. As a matter of fact, 1929, 



Clarke The Burden of Syphilis and Gonorrhea in New Orleans 


167 


appears from hospital records to have 
been the high point in the number of 
cases of syphilis admitted for treatment. 

The point, however, that it is desired to 
emphasize at this time is a comparison in 
the number of cases of venereal diseases, 
so-called, with the number of cases of 
other common and important diseases. 
Table 3 gives the number of cases reported 
for a number of important diseases, 1928 
to 1930, Figure 3 shows a comparison be- 
tween them, and syphilis and gonorrhea. 


infectious disease in Louisiana and New 
Orleans, and if taken together with gonor- 
rhea and chancroid, is even more domin- 
antly the most important single public 
health question at present faced by the 
City of New Orleans and the State of 
Louisiana. Not only so, but New Orleans 
being the largest and most important city 
of the State reports a disproportionately 
large percentage of the total number of 
cases notified to the State health authori- 
ties. This is doubtless due to many fac- 


TABLE 3. CASES REPORTED TO STATE BOARD OF HEALTH, 1928-29-30. 


Year 

Pulmonary 

Tuberculosis 

Measles 

Pneu- 

monia 

Gonor- Gonorrhea 

rhea New Orleans 

Syphilis 

State 

Syphilis 
New Orleans 

Malaria 

1928 

2,338 

5,530 

3,146 

2,224 

1,376 

4,163 

3,693 

1,789 

1929 

2,415 

1,811 

3,394 

1,202 

876 

2,767 

2,436 

1,495 

1930 

1,786 

2,267 

1,273 

973 

973 

2,436 

2,146 

1,001 

Total... 

6,539 

9,127 

8,807 

4,699 

3,225 

9,366 

8,275 

4,285 





tors, 

among 

which 

may be 

mentioned 



Fig. 3. Morbidity Reports to State Board of Health 
1928-29-30. 


Syphilis will be seen to be substantially 
higher than any of the other reported 
diseases when a three-year period is taken 
into consideration. The figure further 
indicates that 88 per cent of the cases of 
syphilis reported to the State Board of 
Health were reported from the City of 
New Orleans, and 69 per cent of the gonor- 
rhea, and it is interesting to note in this 
connection that New Orleans includes only 
about 21 per cent of the population of the 
State as a whole. 


Thus it is seen that the burden of syphi- 
lis alone is greater than any other single 


fact that many patients suffering from 
syphilis and gonorrhea are attracted to 
New Orleans for competent treatment and 
hospitalization. Large state institutions, 
such as the Charity Hospital, contribute 
heavily to the cases reported to the State 
Board of Health. 


Table 4. Certain Morbidity and Mortality Statis- 
tics from the Biennial Report of the Board of 
Health for the Parish of Orleans and the City 
of New Orleans (1925-1930 inclusive). 

White Colored 

Cases Death Cases Death 


Malaria 521 18 74 15 

Pneumonia .. 2,071 1,794 2,249 2,038 

(Smallpox 38 128 2 

Tuberculosis 3,349 1,994 2,582 2,046 

Chancroid 698 1 530 

Gonorrhea 4.864 6 3,576 

Syphilis 5,018 334 12,410 717 


Bearing in mind the fact that 88 per cent 
of the cases of syphilis reported to state 
boards of health are from the city of New 
Orleans, it is interesting to review the 
statistics of mortality due to syphilis dur- 
ing the years 1928 and 1929. Tables 4 and 
5 compiled from official records give an in- 
teresting picture of the distribution of 
mortality due to syphilis by age and color 


168 


Clarke — The Burden of Syphilis and Gonorrhea in New Orleans 


in recent years. In 1928 there were 500, 
and in 1929, 456 deaths reported to the State 
Board of Health. In 1929, this equalled 
a rate of 28 per 100,000 of the white 
population, and 302 per 100,000 Negro. 
The proportion of colored to white persons 
in New Orleans is about one to three. This 
preponderance of death due to syphilis 
among colored persons is of interest, but 
it is only in harmony with the greater in- 
cidence of syphilis among colored people 
as found by our prevalence study, and 
other investigations which have been made 
both among rural and city population. 


Table 5. Deaths from Syphilis by Color and Age, 
1928-1929. 

Reported to State Board of Health. 

White Colored 



1928 1929 

1928 

1929 

Under 1 year 

19 

12 

93 

83 

1 year 

1 

3 

10 

6 

2 years 

1 

0 

3 

2 

3 years 

0 

0 

1 

2 

4 years 

1 

0 

0 

0 

5-9 years 

0 

0 

1 

1 

10-14 “ 

1 

0 

2 

6 

15-19 “ 

1 

2 

16 

12 

20-24’ “ 

2 

2 

38 

29 

25-29 “ 

3 

4 

39 

25 

30-34 “ .... 

5 

7 

33 

15 

35-39 “ 

2 

8 

28 

36 

40-44 “ . 

8 

12 

34 

35 

45-49 “ 

14 

9 

31 

23 

50-54 “ 

6 

13 

28 

34 

55-59 “ .. 

7 

7 

17 

14 

60-64 “ .. 

5 

4 

21 

8 

65-69 “ 

3 

9 

14 

11 

70-74 “ 

2 

3 

10 

4 

75-79 “ 

3 

1 

3 

4 

80-84 “ 

0 

0 

2 

4 

85-89 “ 

0 

0 

0 

1 

90-94 “ 

0 

0 

0 

0 

95-99 “ .... 

0 

0 

0 

0 

100 years and 

over 0 

0 

0 

0 

Unknown . 

1 

0 

1 

5 

Total 

85 

96 

415 

360 

Over the 

two-year 

period 

covered in 

Table 5, 32 

per cent 

of all 

deaths 

from 


syphilis occurred in individuals under one 
year of age, both colored and white. The 
total infant mortality rate for New Orleans 


was 78 per thousand births in 1928, and 
80 in 1929. Syphilis caused 14 per cent of 
all infant deaths in 1928, and 12 per cent 
in 1929. These are of course the infants i 
born of syphilitic mothers and they die of : 
congenital syphilis, a condition which is j 
easily preventable by suitable treatment in 
pregnancy. 

The biennial reports of the New Orleans ! 
Health Department give some interesting ; 
figures as to stillbirths in public and , 
charitable institutions. During the period ! 
1925 to 1930 inclusive, there were 1,706 
white stillbirths and 1,216 colored still- 
births, a total of 2,922. The appended 
Table 6 gives the figures by years. 


Table 6. Stillbirths in New Orleans. New Or- 
leans Health Department. Mortality in Public 
and Charitable Institutions. 


Year White Colored White and Colored 

1925 307 219 526 

1926 310 194 504 

1927 292 250 542 

1928 296 257 553 

1929 247 154 401 

1930 254 142 396 


Total .... 1,706 1,216 2,922 


It is satisfactory to notice that both in 
the co’ored and white groups there has 
been a marked decrease. Syphilis is the 
greatest single cause of stillbirth. Profes- 
sor J. Whitridge Williams, of Johns 
Hopkins University, makes the following 
Statement: “Of 302 fetal and neonat'al 

deaths resulting from 4,000 pregnancies, 
34.4 per cent were due to syphilis.” The 
reduction in the number of stillbirths is 
attributed to some extent at least to the 
better and more universal recognition and 
treatment of syphilis as a complication of 
pregnancy. The prenatal clinics at the 
Charity Hospital and at the Touro In- 
firmary, and the excellent work of the 
Child Welfare Association in recognizing 
and treating syphilis in pregnancy must 
have resulted in a marked reduction in the 
number of stillbirths due to this disease. 


Clarke — The Burden of Syphilis and Gonorrhea in New Orleans 


169 


Unfortunately, exact figures as to the result 
of treatment of syphilis in pregnancy are 
not available in New Orleans as recent 
studies of the results of the excellent work 
of these three institutions have not been 
made. 

Not only in New Orleans, but elsewhere 
throughout the United States, the reporting 
of deaths due to syphilis is notoriously 
incomplete. Yet, during the year 1928, 
there were in the State of Louisiana 500 
deaths from syphilis, 16 from tabes dor- 
salis, and 56 from general paralysis of the 
insane. (Table 7.) 


Table 7. Excerpt from Biennial Report of the 
Louisiana State Board of Health. 


Deaths by Causes and Color, 1928-1929. 

1928 1929 

Total White Colored’ Total White Colored 


Syphilis 

500 

85 

415 

456 

96 

360 

Tabes Dorsalis .... 
General Paralysis 

16 

6 

10 

19 

14 

5 

of the insane 

56 

27 

29 

72 

23 

49 


During 1929, there were 456 deaths from 
syphilis, 19 from tabes dorsalis, and 72 from 
general paralysis of the insane. The above 
table gives a clear indication of the great 
preponderance of colored individuals among 
those who died of syphilis, including its late 
manifestations. These figures unfortunately 


pital as in-patients come the wrecks of 
untreated or inadequately treated syphilis 
patients occupying beds in practically every 
ward of the hospital. The study of the 
Charity Hospital report for the years 
1927 to 1930 show the burden borne by 
that institution, due to syphilis, gonorrhea, 
and chancroid. The pathological reports of 
the hospital were studied with a view to 
learning how many patients were admitted 
to the hospital because of syphilis, and 
what eventually happened to these patients. 
During the four years under consideration, 
4,776 patients having syphilis, gonorrhea, 
or chancroid, occupied hospital beds. These 
of course were in addition to the very large 
numbers treated as out-patients in the 
clinics of the hospital. As would be ex- 
pected, by far the largest proportion of 
these were cases of syphilis, and of the 
cases of syphilis more than twice as many 
were colored patients as were white. Taking 
syphilis alone, we find that the results are 
not encouraging, as the total mortality rate 
for cases admitted was 77.6 per thousand 
cases. The case mortality rate for white 
patients was 86.2 per thousand and for 
colored patients 74.4. Table 8 gives a sum- 
mary of the analysis of the records of the 
hospital for the four-year period under 
consideration : 


Table 8. Charity Hospital 

Number of Cases and Results of In-patient Treatment for 1927-1930. 


Diseases 

W. 

C. 

T. 

W. 

C. 

T. 

W. 

C. 

T- 

W. 

C. 

T. 

W. 

C. 

T. 

Syphilis 

1,067 

2,365 

3,451 

1 

1 

2 

560 

1,370 

2,030 

413 

718 

1,131 

92 

176 

268 

Gonorrhea 

606 

445 

1,051 

20 

20 

40 

396 

327 

723 

212 

110 

322 

0 

1 

1 

Chancroid 

68 

206 

274 

0 

2 

2 

47 

148 

195 

21 

56 

77 

0 

0 

0 

Total 

1,741 

3,015 

4,776 

21 

23 

44 

1,003 

1,845 

2,948 

646 

884 

1,530 

92 

177 

269 


say nothing about the large number of 
individuals who died of cardio-vascular 
disease due to syphilis. It is estimated that 
at least 15 per cent of all the deaths due to 
heart disease are the result of syphilis. 

It is at the Charity Hospital that the 
largest number of cases of syphilis and 
gonorrhea are treated. To this great hos- 


Syphilis Case Mortality Rate — 


White 86.2 per thousand 

Colored 74.4 “ “ 

Total 77.6 “ 


Bearing in mind that syphilis and gonor- 
rhea are preventable diseases and curable 
when adequately treated in their early 


170 


Clarke — The Burden of Syphilis and Gonorrhea in New Orleans 


stages, the loss of life and efficiency, the 
loss of time, and the cost of treatment pre- 
sented by the above table, is an impressive 
argument for devoting more attention to 
the prevention of these diseases and to 
their early and efficacious treatment. 

When the Charity Hospital was first 
placed in operation in 1735, it doubtless in- 
cluded among its earliest patients some who 
were there because of syphilis — patients 
who complained of paralysis, heart trouble, 
liver disease, threatened blindness or deaf- 
ness, diseased joints, chronic ulcers, and 
other conditions due to syphilis which 
under various names are to be found occu- 
pying beds in all departments of general 
hospitals. It is appalling to think of the 
host of syphilitic patients who have, since 
its foundation, passed through the doors 
of this great institution. Some comprehen- 
sion of the numbers may be gained from the 
fact that on one certain day in February, 
1931, there were by actual count, 1,191 cases 
of syphilis under treatment by the hospital, 
of whom 1,011 were in the out-patient de- 
partment, and 180 were in in-patient 
departments. In addition, there were 486 
cases of gonorrhea, all but 36 of whom 
were being treated as out-patients. This 
gives us a total of 1,667 cases of syphilis 
and gonorrhea, who on a particular day 
were under treatment of the Charity 
Hospital. One cannot venture even a guess 
as to the probable number of cases of 
syphilis and gonococcal infections to which 
the hospital has ministered during the two 
hundred years of its existence. 

According to the figures obtained in the 
course of the present survey there were 
among the total of 1,667 patients in the care 
of the hospital on February 2 ; 1,339 whose 
residence was given as New Orleans, the 
remaining 328 came from other points 
within the State of Louisiana, with perhaps 
a few from outside the state. Of the total, 
432 were white, and 1,235 were colored. 
Thus, it is seen that colored New Orleans 
patients constitute 75 per cent of the burden 
of the Charity Hospital in caring for 


syphilis and gonorrhea. The details are 
given in the table below: 


Table 9. Location of residence of patients re- 
ported under treatment or observation at 
Charity Hospital as of February 2, 1931 

In-Patient 

Residence — Syphilis Gonorrhea 

Within New Orleans 114 13 

Outside New Orleans 66 23 

Total 180 36 

Out-Patients 

Residence— Syphilis Gonorrhea 

Within New Orleans 818 394 

Outside New Orleans 193 46 

Total 1,011 440 


The cost per patient per day in the 
Charity Hospital is at a remarkably low 
figure. The following table gives the cost 
in the out-patient and in-patient depart- 
ments of the past four years : 


Table 10. 



Cost per patient 

per day — 1927 

1928 

1929 

1930 

Out-patients ..$ .25 

$ .22 1-3 

$ .21 

$ .25 

In-patients .... 1.74 

1.70 

1.58 

1.53 


In commenting upon this remarkably low 
figure, the report of the Charity Hospital 
for 1928 made the fofiowing statement: 
Certainly this is a record of which we 
need not be proud. That it can be done at 
all is due solely to the economics and stint- 
ing on necessities forced upon us in order 
to keep within our appropriations, which, 
compared with similar institutions, are 
appallingly small.” 

The costs of care at the Charity Hospital 
in 1930 were, for in-patients, $1.53, and for 
out-patients, 25c per patient per day. In 
1930, there were the huge number of 
37,277 visits for the treatment of syphilis, 
gonorrhea, and chancroid, in the out-patient 
department of the Charity Hospital, which, 
at a cost of 25c per day, would amount to 
$9,319. During the same year about 


Clarke — The Burden of Syphilis and Gonorrhea in New Orleans 


171 


11,100 doses of arsphenamine were admin- 
istered in the out-patient department.* 

‘It is fair to add something' to the average 
'cost per treatment as this compound is 
comparatively expensive. At the low esti- 
mate of 10c as a surplus to the average of 
25c per patient, per day, we would have to 
add $1,110 to our total of $9,319, making a 
total of $10,429 for the treatment of vene- 
real diseases in the out-patient department 
i of the hospital. 


Such patients as are absolutely in need 
of hospitalization are usually placed in the 
Genito-Urinary Ward of the Hospital. In 
this department, there are 85 beds available 
for genito-urinary patients, including those 
suffering from complications of syphilis and 
gonorrhea. Of these 85 beds, 42 are assigned 
to white patients and 43 are assigned to 
colored patients out of the total of 1,756 
beds in the hospital. 


Table 11. Work of “Genito-Urinary Clinics” 




Charity Hospital. 





Out-Patient Department 






1927 

1928 

1929 

1930 

Total 

No. 

No. 

No. 

No. 

No. 

microscopic examinations 

patients referred to hospital 

doses of arspenamine 

doses of tartar emetic 

doses of tartar emetic 

899 

280 

9,313 

321 

321 

1,062 

294 

11,451 

431 

481 

791 

357 

11,108 

674 

674 

248 

1,179 

Total number of treatments.. 

30,771 

37,752 

38,425 

37,277 

144,225 


It is difficult to estimate the cost of the It is well known of course that the vast 


in-patient treatment of syphilis and gonor- 
rhea, as these conditions frequently were 
present as a complication rather than as a 
primary cause of hospitalization. For the 
purposes of a rough estimate, we may use 
the hospital report figure of 978 cases of 
syphilis treated as in-patients in 1930. 
These syphilitic in-patients are assumed to 
have remained thirty days each in hospital. 
The 293 gonorrhea in-patients are assumed 
to have spent fifteen days in hospital. 
This gives us 29,340 patient days for 
syphilis, and 4,395 patient days for gonor- 
rhea; a total of 33,735 patient days, which 
at $1.53 would cost the hospital $51,614.55. 

Adding this $51,614.55 for in-patient care 
to the $10,429 for out-patient treatment, we 
have a total of $62,043 as the estimated 
cost of syphilis and gonorrhea to the 
Charity Hospital alone in the course of 
the year 1930. 


*The exact number of doses of arsphenamine 
administered in 1930 was not available at the time 
of the survey; hence the approximate figure for 
1929 has been used in this calculation. 


majority of cases of early syphilis and acute 
gonorrhea can be adequately treated as out- 
patients, so that this is not an unusually 
small number of beds for the genito-urinary 
patients. There are but few cities that 
provide adequately for the hospitalization 
of patients suffering from syphilis or gonor- 
rhea. The point to be emphasized here is 
the small cost of out-patient treatment as 
compared with bed treatment — in 1930 it 
was 25c per patient visit as compared with 
$1.53 per patient day. The sound policy, 
therefore, is so to perfect the out-patient 
care of indigents having syphilis or gon- 
orrhea that they may not later become 
through neglect or insufficient treatment, 
occupants of hospital beds. 

A routine Wassermann is done on prac- 
tically all admissions to hospital — a very 
commendable practice. The work of the 
hospital laboratory in making Wassermann 
tests of blood and spinal fluid during the 
period 1926-30 inclusive is shown in the 
table following: 


172 


Clarke — The Burden of Syphilis and Gonorrhea in New Orleans 


Table 12. Charity Hospital. 

Work of the Hospital Pathology Department. 


For 71,064 visits to the Genito-Urinary 
clinic during the six-year period, the cost 


Wassermann (Blood and Spinal). 


to the hospital would at the 1930 rate have 


Blood Spinal 

1926 32,398 1,243 

1927 32,728 1,337 

1928 29,347 1,184 

1929 39,918 2,030 

1930 43,211 2,026 


Total 177,602 7,820 


It has been estimated that in a large 
laboratory of a northern city the cost of per- 
forming a Wassermann blood test is about 
40c. The cost of the spinal Wassermann is 
not less. At this cost rate the work of the 
Charity Hospital Laboratory in performing 
43,211 blood Wassermanns and 2,026 spinal 
Wassermanrs, a total of 45,237 in 1930, 
would have been $18,094.80. Perhaps the 
cost rate in New Orleans is less than 40c, 
but the total cost for performing more than 
185,000 Wassermann tests in the course of 
five years was surely a large sum. 

The Charity Hospital is free in all its 
departments and services; that is, it is free 
to the patients who are accepted for treat- 
ment, the cost of medical care being borne 
by the tax payers of the state and from 
various endowments and gifts. There are 
other hospita 7 s, however, that provide “Part 
pay” medical care both to in-patients and 
out-patients, including those havings syph- 
ilis and gonorrhea. Part pay patients are 
those who cannot pay the full cost of 
medical care but who can contribute toward 
that cost. The Touro Infirmary conducts 
clinics for the treatment of syphilis and 
gonorrhea, called the genito-urinary (G.U.) 
clinics. Some of the patients are part pay 
patients, but most of them pay little or 
nothing at all. 

According to figures kind’y provided by 
the Touro Infirmary for the Genito-Urinary 
clinic, there were in the six-year period 
1925-30 inclusive, 4,842 patients who made 
71,064 visits to the clinic. The average cost 
per patient visit was 77c for the year 1930. 


been $54,719.28. 


Figures are available showing the 
amounts collected during 1929 and 1930 
from patients attending the Genito-Urinary 
clinic for the administration of salvarsan. 
In 1929, the number of patients visits to 
the “Salvarsan Clinic” was 3,790, and from 
these $474.75 was collected, an average of 
12c per patient visit. In 1930, the patients 
visit to the Salvarsan Clinic numbered 
3,077, and $136.00 was collected. This gives 
an average of $0.04. 


There are many instructive points to be 
noted in a study of these records. From ! 
January and February, 1929, there was a I 
rapid fall in the average amount paid per | 
patient visit, but the lowest average was I 
reached in February, 1930. Again, the 
seasonal variation in attendance at the clinic I 
shows the heaviest case load is carried dur- j 
ing the spring and summer months. There 
are over 800 fewer patients in 1930 than in 
1929. The association of these facts with 
the present economic depression and unem- 
ployment raises many serious questions. 
(Figure 4.) 


A study of hospitals and clinics of New 
Orleans, made in 1926, under the auspices 
of the Central Council of Social Agencies, 

No. Patient 

Visits Fees In. 

Cents 



Fig. 4. Number of Patient Visits and Average Fees- 
Collected in Salvarsan Clinic, Touro Infirmary, New Orleans,. 
1929 and 1930. 


Clarke The Burden of Syphilis and Gonorrhea in New Orleans 


173 


indicated that, as compared with other 
cities, New Orleans ranked high in pro- 
vision of hospital care for her citizens. 
New Orleans ranked third in cities of 
similar size in the number of hospital beds 
per thousand population. New Orleans was 
fourth in the number of patients per 
thousand population, fifth in the number 
of days care. New Orleans ranked seventh 
in the amount per capita spent for hospitals, 
and sixteenth in the cost per patient day. 
The most interesting fact, however, was 
that New Orleans was first in the amount 
of free work done by hospitals of the city. 
In the hospitals of New Orleans, of the beds 
allocated to white patients, 57.4 per cent 
were free, and of the beds allocated to 
colored patients, 92.4 per cent were free. 
There were in the city’s hospitals, 6.06 beds 
per thousand colored persons, and 6.48 per 
thousand white persons. 

As to the clinics of New Orleans, the city 
stood second in per capita expense for all 
clinics; and first in the number of patients 
per capita, one out of every 2.6 persons in 
the city were clinic patients during a given 
period. New Orleans stood first also in the 
number of visits to clinics. It is important 
to notice that of these visits the ratio of 
colored to white was two colored to one 
white, while the ratio of the population 
was one colored to three white. On the 
basis of its investigation, the Committee 
in charge of this study of hospitals and 
clinics in New Orleans made the following 
statement : 

“The Committee believes that the fol- 
lowing conclusion is warranted : That the 

large amount of free hospital service and 
of clinic usage, which is not a proof or 
even a positive indication of hospital abuse 
(by patients who should pay), neverthe- 
less points to a need in all hospitals for a 
careful study of this particular aspect of 
its intake problem.” 

The recent report of the Registration of 
Social Statistics of the University of 
Chicago, Departments of Hospitals, In- 


patients, Out-patients, and Dispensaries, 
contained some interesting references to 
the situation in New Orleans. In eighteen 
cities, with a total estimated population of 
6,053,000, the number of visits to clinics 
and dispensaries in 1929, was approxi- 
mately 2,400,000, or 396 per thousand 
population. A comparison of the number 
of visits per thousand population in 1928 
and 1929 shows that the volume of service 
reported by New Orleans far exceeds in 
both years the volume of service reported 
by any other city. As a matter of fact, it 
is about three times the nearest highest 
rival, which is Cincinnati. In 1929, the 
number of visits to clinics and dispensaries 
per thousand in New Orleans was 1,245, 
whereas Cincinnati, the next highest, was 
438 per thousand. This means that in 
New Orleans there was more than one 
visit per capita of population. Of the 
total number of visits to New Orleans 
clinics in 1929, 85.7 per cent were free 
visits, 5.7 per cent were “part-pay” visits, 
and 8.6 per cent were “pay” visits. The 
figures for certain other large cities may be 
compared with those of New Orleans. Thus, 
71.9 per cent of visits in Detroit, and 49.0 
per cent of visits in Cleveland were free 
visits, with correspondingly lower percent- 
age in the categories of “pay” and “part^ 
pay” visits. 

The above facts have been introduced 
because it is believed that they indicate that, 
in the clinics and hospitals of New Orleans, 
far more free medical care is provided than 
in most American cities. Observations made 
in the course of the present study of clinics 
and hospitals seem to indicate that what is 
true of the general hospital and clinic 
situation in New Orleans is equally true for 
patients suffering from syphilis and gonor- 
rhea, namely, that the proportion of free 
patients is unusually high. This may 
account for the over crowding of certain 
venereal clinics in New Orleans. The 
Charity Hospital is a free hospital sup- 
ported by state funds, but the facts brought 
out above in regard to the Touro Infirm- 


174 


Underwood — A ppraisal of County Health Work 


ary, a private institution supported by 
funds from the Community Chest and 
from private donors, indicate that, even in 
a privately supported clinic, only a small 
number of patients can be classified as 
“pay” or “part-pay” patients. 

Figures are not available upon which may 
be based estimates for the expenditure by 
the small clinics for the care of patients 
suffering from syphilis and gonorrhea, 
notably the City Health Department Clinic, 
the Mercy Hospital Clinic, and the St. Marks 
Community Center Clinic. The figures 
estimating the cost of medical care at the 
Charity Hospital, and the estimate based 
upon the incidence rate as established in 
the course of our prevalence study may be 
sufficiently impressive to bring home to 
readers of this report the enormous waste 
suffered by New Orleans and the State of 
Louisiana due to syphilis and gonorrhea. 
Our figures do not include any estimate of 
the great cost for caring for victims of 
general paralysis of the insane, and other 
varieties of neuro-syphilis, who during long 
periods require institutional care in mental 
hospitals. The costs of these diseases, how- 
ever, cannot be estimated in dollars and 
cents, but are rather to be appreciated by 
case studies of individual patients, and 
their families. To spend more money on 
the prevention of these diseases, and on 
efforts to bring infectious individuals under 
treatment early, and to keep them under 
supervision until they are at least non-, 
infectious, would be better public health 
po 7 icy, more humane, and better economics, 
than to care for the wreckage of syphilis 
and gonorrhea after these diseases have 
done their worst, and when there are no 
longer possibilities of cure. 

In 1905, $250,000 was spent on a cam- 
paign against yellow fever in New Orleans. 
Today yellow fever is practically unknown 
in this section of the United States. Other 
large sums of money have been spent for 
the conquest of typhoid fever, and of small- 
pox, with brilliant resu’ts. The public 
health problems presented by syphilis and 


gonorrhea, are in some ways more difficult, 
and in other ways simpler than those of the 
previously mentioned diseases. We have 
methods for preventing and for curing both 
syphilis and goporrhea, but in order to deal 
successfully with these diseases, the medical 
profession and health officers must have 
placed in their hands adequate financial 
resources, and adequate personnel with 
which to apply the established and proved 
methods of control. One of the greatest j 
American authorities on public health, 1 
Dr. Hermann Biggs, asserted that “public 1 
health is purchasable, and within certain j 
limits, any community can determine its ! 
own death rate.” New Orleans can suc- 
cessfully combat syphilis and gonorrhea if 
adequate resources are made available to ] 
the medical and health authorities of the j 
city, many of whom are numbered among J 
the most distinguished of the United States, j 

APPRAISAL OF COUNTY HEALTH 

WORK BASED ON REDUCTION OF 
MORBIDITY AND MORTALITY.* 

FELIX J. UNDERWOOD, M. D.,f 
Jackson, Miss. 

Since the avowed purpose of county 
health work is the reduction of the so- 
called preventable diseases, it is logical 
to conclude that a fair appraisal of the 
results achieved by a county health depart- 
ment can be secured by an examination of 
the morbidity and mortality prevailing in a 
county before and after the inauguration of 
this activity, as well as by a comparison 
with the trend in the state at large. The 
county health departments in the State of 
Mississippi have been carrrying on what 
may be regarded as a well-rounded pro- 
gram, considering their limited resources. 
The varied character of their programs 
coup’ed with their limitation of resources 
increases the difficulty of demonstrating 
tangible accomplishments in the prevention 

*Read before the Louisiana State Medical 
Society, New Orleans, April 14-16, 1931. 

■{■Mississippi State Health Officer. 


Underwood — Appraisal of County Health Work 


175 


of specific diseases. However, a survey of 
the situation led to the conclusion that an 
examination of our experience with typhoid 
fever would afford some insight into this 
question. This appeared likely from the 
circumstances that since the inauguration 
of these departments the State Board of 
health has consistently insisted that the 
improvement in the disposal of human ex- 
creta and the immunization of susceptible 
persons were the most practical means 
available to these departments to deal with 
the problem of this endemic. It, therefore, 
appears worthwhile to critically examine 
the accomplishments of these departments 
to ascertain whether demonstrable reduc- 
tion in typhoid fever incidence has occurred 
which can be attributed to these activities. 

This study was limited to those counties, 
nine in number, in which full-time health 
departments were organized prior to 1925, 
in order to have a minimal period of five 
years over which to study their effect. 
They were organized during the period 
1917 to 1925. The periods for study were 
the three years immediately preceding 
organization and the five years subsequent 
thereto. 

The counties were divided for study into 
two groups: Group No. 1, with less than 

one inoculation per person for the five-year 
period immediately following organization ; 
group No. 2, with more than one inoculation 
per person for the five-year period imme- 
diately following organization. 

The extent of privy construction is not 
appreciably different in either group for the 
five-year period following organization in 
each of which the data indicate that ample 
construction opportunities still exist. 

The differences noted in typhoid fever 
incidence appear to be attributable to the 
more extensive vaccinations. 

The following summary is given as a 
resu 7 t of the study of the chart of Lee 
and Forrest Counties when compared with 
the State at large. Full-time service was 


inaugurated in Lee County in 1919. The 
average annual case rate for typhoid fever 
for the five years prior to organization was 
41.1 per 10,000 population with an annual 
death rate from this disease of 3.38. The 
case and death rates for the State at large 
for the same period were 32.21 and 3.41, 
respectively. The average annual case and 
death rates for Lee County for the eleven 
years of full-time service were 12.1 and 1.1, 
respectively, while the State case and death 
rates during this period were 13.57 and 
1.78. The Lee County case rate was re- 
duced from 41.1 to 12.1, while the rate for 
the State was reduced from 32.21 to 13.57, 
and the Lee County death rate reduced from 
3.38 to 1.1 and the State rate from 3.41 to 
1.78. The explanation of this perceptible 
difference in reduction lies in the fact that 
approximately 20 per cent of the homes 
in Lee County were provided with safe 
methods of excreta disposal and the accu- 
mu'ated inoculations amounted to 1.87 doses 
per person in the county. It is confidently 
felt that had better results in sanitation 
been secured greater difference could be 
observed. 

The verity of this statement is seen by 
reference to the Forrest County chart. 
This represents eight years before and 
after the establishment of full-time service. 
The annual case and death rates in Forrest 
County during eight years of part-time 
service were 23.95 and 3.41, respectively, 
while the State case and death rates for 
the same period were 26.35 and 2.87. Why 
this 'ow endemic rate in Forrest County? 
During 1916, the State Board of Health 
waged a very successful anti-soil pollution 
campaign in that county. During the war, 
Camp Shelby was located in this county and 
the public health service maintained an 
extra cantonment sanitation station in this 
area. The report of the surgeon shows that 
6,170 people were inoculated, but no record 
is given of changes in methods of excreta 
disposal. However, the writer knows from 
personal observation that the City of Hat- 
tiesburg was cleaned up in this respect. 


176 


Underwood — Appraisal of County Health Work 


Since its organization, the local health de- 
partment has almost completely sanitated 
the county, more than 90 per cent of the 
homes having been provided with a sani- 
tary method of excreta disposal, and has 
administered 1.61 doses of typhoid vaccine 
per person in the county. What effect, if 
any, has this vaccination and sanitation 
campaign had upon the typhoid rates? For 
eight years of full-time service the average 
annual case and death rates were 5.25 and 
.41, respectively, while the average annual 
case and death rates for the State at large 
for the same period were 12.44 and 1.72, 
respectively. This was a reduction in case 
rate from 23.95 to 5.25, in Forrest, as 
compared to a State reduction from 26.35 to 
12.44 and a reduction in Forrest in death 
rate from 3.41 to .41, while the State death 
rate reduction was from 2.87 to 1.72. 

In Forrest County the initiation of privy 
construction was not followed by a marked 
decline in typhoid fever incidence which 
became apparent only when extensive vac- 
cination was first practiced. In most of the 
counties, judging from the experience in 
Lee and Forrest, satisfactory results in 
reducing typhoid fever incidence will not be 
secured until the inoculation rate indicates 
that approximately two-thirds of the popu- 
lation has received the complete course of 
three inoculations. While the experience 
in Lee County indicates that vaccina- 
tion largely alone will materially reduce 
the typhoid fever incidence, the experience 
in Forrest County indicates that where a 
vaccination program is combined with sani- 
tation a higher degree of reduction is 
secured. 

After five years of operation many of 
our county health departments have not yet 
either sufficiently promoted vaccination or 
sanitation to the point where they are 
showing the satisfactory effect on typhoid 
incidence. 

Complete sanitation and immunization of 
at least two-thirds of the population shouM 


be the minimal goal for the typhoid 
campaign. 

In order that proper conclusions may be 
drawn when comparing the morbidity and 
mortality rates of the State as a whole with 
the rates of the counties included in this 
study, it is noted that for the period 1920 
through 1929, counties which have always 
had a part-time health service have had 
approximately one-half as many inocula- 
tions per ten thousand persons as the 
counties included in this study. 


THE AVERAGE ANNUAL CASE AND DEATH RATE 
PER 10,000 POPULATION, FROM TYPHOID FEVER FOR 
LET AND FORREST COUNTIES AS COMPARED TO THE 
STATE AT LARGE FOR CORRESPONDING PERIODS. 






Case Rates 

Death Rates 





Lee 


Lee 






County 

State 

County 

State 

5 

years 

part-time 

service 

41.1 

32.21 

3.38 

3.41 

5 

years 

full-time 

service 

12.1 

13.57 

1.1 

1.78 





Forrest 


Forrest 






County 

State 

County 

State 

8 

years 

part-time 

service 

23.95 

26.35 

3.41 

2.87 

8 

years 

full-time 

service 

5.25 

12.44 

.41 

1.72 


CONCLUSIONS. 

1. Effective work in disease prevention 
requires that activities of county health 
departments be largely limited to measures 
of proven value in the control of specific 
diseases. 

2. The most tangible results of county 
health work are manifested in the reduction 
of the incidence of specific diseases occur- 
ring as a sequel to the effective application 
of specific measures. 

3. This trend can be satisfactorily 
demonstrated only when satisfactory and 
adequate records are kept by the county 
health organizations. 

4. When these records fail to show an 
adequate reduction in disease incidence, 
after a reasonable length of time, it may 
be inferred that the activities of the local 


Underwood — Appraisal of County Health Work 


177 


health departments are insufficient to deal 
with the situation and are ample justifi- 
cation for the intervention of the central 
organization. 

5. A typhoid fever vaccination rate of 
two-thirds of the population will show a 
marked reduction in the morbidity and 
mortality from typhoid fever. 

6. A typhoid fever vaccination rate of 
two-thirds of the population and a sanitary 
privy rate of 95 per cent of homes will 
reduce the rate more than vaccine alone. 

DISCUSSION. 

Dr. J. George Dempsey (New Orleans) : It is 

a pleasure to have this opportunity of opening dis- 
cussion on the paper entitled: “Appraisal of Coun- 
ty Health Work Based on Reduction of Morbidity 
and Mortality” by Dr. Felix J. Underwood, State 
Health Officer for Mississippi. 

So long has he been actively identified with 
health work in Mississippi that I dare say Dr. 
Underwood’s name is as well known in his native 
state as that of Bilbo or Harrison. Having been 
a constant visitor to Mississippi myself for the 
past forty years, I can appreciate all the more 
the decided advancement in health matters that 
has been made in that state under the skillful 
leadership of Dr. Underwood. 

The opening paragraph of Dr. Underwood’s pa- 
per states with commendable terseness the avowed 
purpose of county health work is, “the reduction 
of the so-called preventable diseases.” Upon first 
reading this statement the thought struck me that 
it would be interesting to canvass our own state 
of Louisiana and find out just how many people 
realized what is the purpose of our parish health 
work. The fact that it is solely for the purpose 
of protecting the health of the people, might 
quicken in those people themselves that spirit of 
co-operation which is such a dire necessity for 
the attainment of the best results. 

Dr. Underwood has shown just what county 
health work is worth. While this appraisal is 
founded only on morbidity and mortality for 
typhoid fever in a county before and after the 
inauguration of county health work, the statistics 
he gives nevertheless do afford an insight into the 
practical value of county health work. 

The following figures and percentages are the 
results of the tabulation in the Vital Statistics 
Department of the Louisiana State Board of 
Health : 


Health Directors 
Death Unit Complete of 



Reported 

Reported 

Rate Per 

Typhoid 

Health 

Year 

Cases 

Deaths 

100,000 

Immunization 

Units 

1921 

1033 

325 

17.8 

6915 

6 

1922 

1085 

323 

17.6 


6 

1923 

922 

265 

14.3 


6 

1924 

1252 

410 

21.9 

19593 

9 

1925 

2318 

639 

34.0 

34306 

11 

1926 

1187 

333 

17.3 

9618 

10 

1927 

1066 

283 

14.6 

98196 

21 

1928 

1049 

262 

13.4 

48026 

29 

1929 

825 

221 

11.2 

83282 

31 

1930 

1145 

247 

11.7 

124337 

31 


In Louisiana the figures on malaria fever may 
also serve the same purpose. I regret that I have 
had only a brief few minutes in which to prepare 
for this discussion, otherwise I would have had 
tabulated a more elaborate set of figures to demon- 
strate this point. However I am pleased to quote 
the morbidity and mortality statistics on malaria 
fever in Louisiana for the past three years: 


1928 

Deaths 

251 

Death Rate per 
100,000 

population Decrease 

12 7 

1929 

...206 

10.4 

2.3 

1930 

...178 

8.4 

2 

Total decrease 

in 1930 

over 3-year period 

4.3 


While it cannot be said that parish health boards 
and units are entirely responsible for this credit- 
able showing, it is quite evident that they have 
been dominant factors in making possible such a 
decided decrease in the death rate from this one 
disease alone. In parish health organization, such 
as sponsored by the State Board of Health and 
the Louisiana State Medical Society, rests the 
secret of the prevention of disease; and one can 
scarcely help agreeing with Dr. Underwood that 
in county health work lies the secret of the pre- 
vention of disease. 

Certainly the Drought Fund voted by Congress 
and allocating $200,000 to each state affected and 
the millions to be spent throughout the United 
States for the White House Conference on Child 
Health and Protection, will augment parish health 
work as it at present exists in Mississippi and 
Louisiana. 

Dr. Underwood (closing) : The reduction of 
morbidity and mortality is the yardstick of public 
health work and the only measure by which we 
may know that we are obtaining good results from 
our program. 


178 Googe — Problems Challenging Doctors and Health Officers in Mississippi 


I wish to thank Dr. Dempsey for his discussion 
of the paper and for the very nice things said 
about the public health program of Mississippi and 
the executive officer of the Mississippi State Board 
of Health. 

SOME OF THE PROBLEMS CHALLENG- 
ING THE DOCTORS AND HEALTH 
OFFICERS IN MISSISSIPPI.* 

J. T. GOOGE, M. D., 

Meridian, Miss. 

In undertaking this discussion it appears 
in order to set forth as clearly as possible 
the aims of the practitioner and the health 
officer. An accepted definition applying to 
the practitioner has been laid down as being, 
“for the relief of pain ; restoration of the 
body from sickness; the prevention of dis- 
ease; the promotion of health; and an ulti- 
mate extension of the life span.” The aims 
of the health officer has been stated as, “for 
the prevention of disease; promotion of 
health, and extension of the life span.” 
From these definitions it appears that 
public health is a special field rightly 
placed in the medical profession. It is 
likewise apparent that the practitioner, 
if he embodies in his activities a well- 
rounded program, should give equal thought 
to preventive measures. Hippocrates, the 
author of the oldest medical treatise in 
existence, the father of medicine, whom all 
doctors honor and revere, in specifying the 
duties of medical men, placed equal im- 
portance on the preservation of health and 
the curing of disease. No physician trained 
in the principles of his profession ignores 
the preventive side of his activities. The 
purpose of this rather vague preamble is to 
impress on our minds that the practitioner 
and health officer are to a great extent on 
common ground. 

Repeated surveys and a look at the mor- 
bidity reports and death certificates as 
they come in from time to time from over 

* Chairman’s Address. Head before the Section 
on Hygiene and Public Health at the iSixty-fourth 
Annual Session of the Mississippi State Medical 
Association, Jackson, May 13, 1931. 


the state disclose that a few causes are 
responsible for the great majority of ail- 
ments and deaths among the young. 
Closely interwoven, united effort on the 
part of the profession would tend to reduce 
diseases and cut down death rates among 
our younger groups in a short time. 

In surveys conducted in various parts of 
the state, it appears that approximately 
34 per cent of the colored population more 
than fifteen years of age, and slightly less 
than 5 per cent of the whites in the same 
age group have a positive Wassermann 
blood reaction. If this be correct, there 
are on the basis of the last census 275,000 
persons now suffering from syphilis 
in this state. Estimates may go wrong; 
let us be conservative and assume that we 
have only half that number, or 137,500. 
(The most skeptical should not doubt the ex- 
istence of this number.) It is estimated 
conservatively that at least 33 per cent, or 
about 45,000 of these patients, are unable 
to pay for treatment. The practicing physi- 
cians can not afford to give their time and 
buy medicine for these cases without hope 
of a return on their investment. It is not 
within the scope of the County Health 
Officer’s duties to do such work, and so he 
does not wish to treat them. These people 
are a hopeless lot confronting us. Does this 
not appear to constitute one of the problems 
confronting the profession, and should it 
not be met by some means through the 
various medical groups, state and commu- 
nity hospitals? There is a consciousness on 
the part of the profession of the tremen- 
dousness of such a problem in this state at 
this time as has never before existed. 

Another health problem that exists in 
certain sections of the state, especially in 
the hill and coastal plain sections, as 
is evidenced by surveys made at different 
times, is the existence of intestinal para- 
sites. In some communities the infestation 
in school groups exceeds 60 per cent. This, 
it seems, is not alone a public health prob- 
lem, but constitutes one of the major 


Googe Problems Challenging Doctors and Health Officers in Mississippi 179 


problems confronting the entire profession. 
Every school chiM and many in other 
groups in these infested areas should be 
examined at least once a year and if found 
to have the disease, should be treated until 
cured. Sanitation of the home and school 
should receive proper consideration with re- 
gard to excreta disposal where the disease 
prevails. 

The 1930 morbidity reports for the 
state registered a total of 50,477 cases 
of malaria. This is probably not ex- 
aggerated. Some cases may have been 
reported as malaria that were not, but many 
cases were not reported, never coming 
under a physician’s care during their illness, 
thus making the total in the neighbor- 
hood of the number reported. A proper 
approach toward the solution of this prob- 
lem is being made in the practice by many 
physicians of making a blood examination of 
all malaria suspects. When this method is 
universally followed, the foci of malaria 
may be fairly definitely charted and means 
applied for its prevention. Close work 
between practitioner, laboratory techni- 
cian, and health officer will be required. 
It appears that progress in greatly re- 
ducing this disease is about to be made 
through the earnest efforts of Dr. Mark F. 
Boyd. 

During 1929 there were 3510 cases of 
tuberculosis registered from morbidity re- 
ports of practitioners in the state. This 
without doubt is incomplete. It is claimed 
by some epidemiologists that there are ten 
active cases of tuberculosis in a community 
for every death occurring therein. If this 
be true, there were about 16,500 cases that 
year, as 1649 deaths were registered. 

Lack of care of mothers during the pre- 
natal, lying-in, and postnatal periods is 
reflected in a total of 584 deaths from 
causes connected with these states regis- 
tered in 1929. Of this number, 326, or 
about 56 per cent, were white. This is food 
for thought. Likewise, a total of 929 deaths 
recorded of children in early infancy in that 


year reflects a condition not met in the 
manner desired. Of this number, 577 were 
white, approximately 62 per cent; likewise, 
food for thought. 

More than 30 per cent of the men 
examined during the World War were 
rejected either by local boards or after they 
reached camp because of physical unfitness. 
It is common knowledge, gained from re- 
ports of physical examinations of school 
children and yearly health examinations 
made by industries and insurance companies 
of other groups, that a large majority of 
both children and adults are in possession 
of one or more physical defects which in- 
terfere with their efficiency and well being. 
A glance at mortuary statistics reflects the 
grim story that too many young people are 
dying. 

For some time there has been a movement 
urging a careful physical examination of 
all persons at yearly intervals with cor- 
rection of defects that may be found. From 
this movement fruit is being borne in a 
gradual extension of the average life span 
as well as improvement in the sturdiness 
of the citizenry. This program, without 
doubt, will yield more far reaching benefits 
if intensified and carried to a larger number 
of people. The practitioner is doing a 
higher type of professional service as a 
result of this phase of his activities. Some 
doctors give special attention to the yearly 
physical examination and correction of de- 
fects, and “call up” their clientele, remind- 
ing them that only a year ago they were 
up for examination and that it is time for 
this to be done again. With such an ar- 
rangement the family doctor is able to keep 
his hands and eyes and mind on the physi- 
ca 1 progress of his people, and could do the 
immunizations against typhoid fever, small- 
pox, diphtheria, and other perventive work 
that he of right should do. (There were 
1315 cases of typhoid, 810 under 20' years 
of age, highest incidence in July, and 1786 
of diphtheria, 1443 in children under ten 
and highest incidence in August, reported 


180 


Anderson — The Role of the General Practitioner in Modern Medicine 


in 1929 with 197 and 162 deaths, respec- 
tively, from these causes.) 

The condition set forth in the preceding 
paragraphs constitute in the mind of the 
writer some of the major problems con- 
fronting the medical profession in this 
state. The challenge: if these problems 

are to be met in the manner calculated to 
yield greatest results, the services of physi- 
cians, health officers, dentists, and nurses, 
with adequate training in their respective 
fields, together with hospitals carrying 
modern diagnostic and therapeutic equip- 
ment, should be in easy reach of every 
community. 


THE ROLE OF THE GENERAL 
PRACTITIONER IN MODERN 
MEDICINE.* 

W. H. ANDERSON, M. D., 
Booneville, Miss. 

The progress of medicine for the last 
fifty years has been as swift as the eagle’s 
flight. No one man has been able to keep 
step with it all. Much that was mysticism 
and guess work has been replaced by scien- 
tific discoveries. The last half century has 
been really the era of curative medicine. 
Now we are at the sunrise of a new day, 
that of preventive medicine and preventive 
surgery. Requirements for graduation in 
medicine have been raised time and again 
and the cost multiplied over and over. 
Specialties have been magnified by the 
medical schools until the profession has 
become top-heavy with specialists. The 
cities are crowded to the utmost limit with 
doctors, while the rural communities are 
starving for the benefits of modern medi- 
cine. Generally speaking, the specialist is 
underworked and overpaid, while the gen- 
eral practitioner is overworked and paid 
barely enough to keep soul and body 
together. 

* Chairman’s Address. Read before the Section 
on Medicine at the Sixty-fourth Annual Session 
of the Mississippi State Medical Association, 
Jackson, May 12, 1931. 


Heart disease heads the list for human 
casualties caused by illness. Prevention is 
the treatment of choice, and this must be 
done largely by the family physician. 
Cancer is another unconquered enemy that 
is successfully defying the medical profes- 
sion, and ranks next in its toll of human 
life. Here the general practitioner must be 
aroused to the importance of early diag- 
nosis. He must have the facilities and the 
time to make the examinations, and his 
observations must be recorded, if we are to 
master this disease. And great is the field 
of preventive surgery, especially as it re- 
lates to good obstetrics. Here the public 
depends largely upon the general man for 
more efficient service in a great and open 
field. Even yet the majority of people 
become iT and die of the common, ordinary, 
every-day diseases and we cannot over- 
estimate the vigilance and efficiency of the 
general practitioner. Preventive surgery 
and preventive medicine are the eastern 
star that beckons us to higher and nobler 
attainments in the service of our profession 
and offers the greatest returns socially and 
economically to us and to our clientele. 
Preventive medicine is not the work of the 
public health officer alone ; its challenge 
reaches to every practitioner. Social ethics 
and better eugenics constitute a field with 
multiplied opportunities open to the medi- 
cal profession where the advice of the 
general practitioner is of the greatest ; 
value. 

The influential leaders in medical thought : 
have underestimated the value and the ; 
importance of the general practitioner. I 
But, say what you will and think what you 
may, he is the corner stone of the pro- : 
fession. There has been a tendency to 
discard as “obsolete” the man who has been 
in practice for twenty-five years. It is true 
that there is much that he does not know in 
laboratory diagnosis, intravenous therapy 
and some of the latest anesthesias. But he 
has a basis, he has the foundation upon 
which the newer knowledge can be built 
easily. He knows the clinical symptoms 


Anderson — The Role of the General Practitioner in Modern Medicine 


181 


from experience, if not from study. He has 
a working knowledge of the human organ- 
ism, how it reacts against disease, and how 
it behaves under stress and strain; he has 
learned in the school of experience. It is 
true that there must be some adjustments 
to aid the practitioner and to enable him 
to better serve the public. 

The general practitioner in medicine or 
surgery should be just as much a specialist 
in his line of work, within its limits, as the 
eye, nose and throat men. His scope of 
work requires him to be more broadly 
educated and more versatile in general than 
the average specialist. The medical school 
should put in a course especially suited to 
the needs of the man who does general 
practice, the man who has been in practice 
for several years, as well as for the student 
who is beginning his course in medicine. 
The short cut to a medical diploma to supply 
physicians to the rural communities will 
not work. It is foolish to think of lowering 
the standards or taking short cuts. Deans 
of medical schools must be more careful 
in selecting their students. Scholarship is 
good and of great importance, but a pro- 
fessional mind, a medical soul, and a 
missionary heart are of still greater im- 
portance. Never has the challenge been so 
gigantic, nor the opportunities so great as 
at this time. 

The general practitioner of medicine and 
surgery is the backbone of the profession, 
but he must have special training in his 
field, technical training for the treatment 
he is to administer, and native endowment 
in addition to this training, to enable him 
to administer his clearing house duties as 
he should. The general man must be able 
to tell when a real specialist is needed in 
the case. He must be big enough of heart 
to turn the case over cheerfully when this 
is evident. He must have ability to put all 
the facts and findings together and to in- 
terpret them in their proper relations to a 
diseased body and a mind disturbed socially 
and economically. The practitioner must 


also study to prove himself a good busi- 
ness man. 

To bring modern medicine to the masses 
at a cost at which they may utilize it is 
our greatest social and economical problem. 
We must make our profit on volume of 
business rather than a high price to the 
individual. In order to do this, the patient 
must come to the practitioner. In a well- 
ordered clinic or a small hospital he can see 
a dozen times as many patients perhaps, 
he can have trained help, the patient will 
come before he is gravely ill. It is better 
for a dollar-a-day man to spend his time 
on the road than it is for a man who has 
spent $10,000 and ten years of hard work 
preparing to practice medicine. It is im- 
possible now to apply modern medicine 
in many instances out in the homes of 
the rural community. Hence, our greatest 
means in enabling the practitioner to serve 
his clientele better and at less cost is the 
community hospital and the well-ordered 
clinic. If our State will take care of the 
actual charity in the territory of the small 
hospital, it can live and serve. The com- 
munity hospital will encourage co-operative 
medicine, promote preventive medicine and 
the yearly examination and act as a post- 
graduate school for the medical profession. 
In this way t the standard of efficiency of 
the general man might be raised to a much 
higher degree and at the same time bring 
modern medicine to the rural community at 
a reasonable cost. It is time for the man 
out at the cross roads and down by the mill 
to have some consideration at the hands of 
his State. He has been paying taxes all 
these years. A charity hospital 200 miles 
away is no good to him. He needs and 
must have the service in his own or adjoin- 
ing county. It is time to “render unto 
Caesar the things that are Caesar’s.” It is 
time to do honor to the general practitioner 
and to remunerate him commensurate with 
the service he is rendering. 

In the meantime, let us keep up the 
morale. Let us not be weary during this 
transitional period from an already great 


182 


McTlhenny — Chaulmoogra Oil in the Treatment of Arthritis 


to a still greater service. You have, you are, 
you will meet the demands. Your reward 
must come. As long as matter goes unde- 
stroyed service must be paid for in some 
form. Let us raise the standard as high 
as we can under the circumstances. Let us 
be efficient to the limit of our ability. Let 
us diagnose and treat the common every- 
day diseases in the very best way we can. 
Let us not count anyone thing common or 
of minor importance in this great profes- 
sion of ours. Let us meet the challenge of 
a needy people. Let us carry on with 
dignity and pride and perseverance. The 
general practitioner is the corner stone of 
the greatest profession on earth. In the 
words of the poet, “Let us walk with the 
man in the road” and “Let us keep on 
keepin’ on.” Let us keep in mind the words 
of Walter Gresham and also heed the 
words of the unknown poet. 

LET ME WALK WITH THE MEN IN THE 
ROAD. 

’Tis only a half truth the poet has sung 
Of the “house by the side of the way”; 

Our Master had neither a house nor a home, 

But He walked with the crowd by day. 

And I think, when I read of the poet’s desire, 
That a house by the road would be good; 

But service is found in its tenderest form 
When we walk with the crowd in the road. 

So I say, let me walk with the men in the road, 
Let me seek out the burdens that crush, 

Let me speak a kind word of good cheer to the 
weak 

Who are falling behind in the rush. 

There are wounds to be healed, there are breaks we 
must mend, 

There’s a cup of cold water to give; 

And the man in the road by the side of his friend 
Is the man who has learned to live. 

Then tell me no more of the house by the road. 

There is only one place I can live — 

It’s there with the men who are toiling along, 
Who are needing the cheer I can give. 

It is pleasant to live in the house by the way 
And be a friend, as the poet has said; 

But the Master is bidding us, “Bear ye their load, 
For your rest waiteth yonder ahead.” 


I could not remain in the house by the road 
And watch as the toilers go on, 

Their faces beclouded with pain and with sin, 

So burdened, their strength nearly gone. 

I’ll go to their side, I’ll speak in good cheer, 

I’ll help them to carry their load; 

And I’ll smile at the man in the house by the way, 
As I walk with the crowd in the road. 

Out there in the road that goes by the house, 
Where the poet is singing his song, 

I’ll walk and I’ll work midst the heat of the day, 
And I’ll help falling brothers along — 

Too busy to live in the house by the way, 

Too happy for such an abode. 

And my heart sings its praise to the Master of all, 
Who is helping me serve in the road. 

—Walter J. Gresham. 


KEEP ON KEEPIN’ ON. 

If the day looks kinder gloomy, 
An’ the chances kinder slim; 

If the situations puzzlin’ 

An’ the prospects awful grim, 

An’ perplexities keep pressin’ 
Till all hope is nearly gone — 
Jest bristle up and grit yer teeth 
An’ keep on keepin’ on! 


CHAULMOOGRA OIL IN THE TREAT- 
MENT OF ARTHRITIS. 

A Preliminary Report.* 

PAUL A. McILHENNY, M. D.,f 
New Orleans. 

In 1926 (1) I announced the observa- 
tion that the secondary infectuous type of 
arthritis is not encountered in leprosy. 
Occupying the position of Orthopedic Con- 
sultant on the staff of the U. S. Marine 
Hospital, No. 66, the National Leprasarium 
at Carville, Louisiana, for a number of 
years I have been able to observe these 
cases, and the fact was so impressed upon 
me that I sought for some reason to explain 
why these unfortunates did not develop 
such conditions. I then arrived at the con- 
clusion that, since leprosy is attended with 
rather marked metabohc disturbances, the 
disease itself could not be preventing an 

*Read before the Orleans Parish Medical I 
Society, New Orleans, June 22, 1931. 

fFrom the Department of Orthopedics, Tulane j 
University, and the Charity Hospital of Louisiana. 


McIlhenny — Chaulmoogra Oil in the Treatment of Arthritis 


183 


arthritis, and I then conceived the theory 
that possibly the treatment of leprosy might 
be the reason. I consulted with my asso- 
ciates on the staff of the hospital, and with 
visiting physicians connected with other 
leprasaria, and without exception my obser- 
vation was sustained in that none of these 
gentlemen could recall having seen arthritis 
of the types considered in lepers. After two 
more years of investigating I concluded that 
chaulmoogra oil was responsible for the 
prevention of this widespread disease. 

It is an established fact that, in the test 
tube, chaulmoogra oil has powerful bacte- 
riacidal properties ; (2) it is also an estab- 
lished fact that it has no deleterious effect 
on any organ of the body when given in 
medicinal doses; it does, however, produce 
gastric irritation when given in large doses 
by mouth, and a local myositis when exces- 
sive amounts are injected intramuscularly. 
With these facts in mind I determined to try 
this drug in the treatment of the atrophic, 
hypertrophic and the mixed, combined or 
altro-hypertrophic types of arthritis. No 
other types of arthritis have been treated 
with it, nor will any other be considered in 
this announcement. The method used con- 
sists of bi-weekly intramuscular injections 
of from 3 to 5 c.c. of the crude oil, and 
from 0.3-1. 6 c.c. in enteric capsules by 
mouth at meal times. The formula for the 
injection material is that of Dr. F. A. 
Johansen, of the National Leprasarium at 
Carville, (3) and consists of 0.2 gm. of 
benzocaine, 10 c.c. of olive oil, and 90 c.c. 
of crude oil. Twenty-four to forty-eight 
hours are required for the preparation 
of this formula. The regions selected for 
injections are the deltoid and buttock. 
Five c.c. may be injected into the deltoid 
alternating with 8 c.c. into the buttock. 
Five c.c. is the amount generally used both 
in the deltoid and buttock though a larger 
amount may be injected if the patient’s 
tolerance allows; the mixture is given at 
body temperature. After injection a slight 
local reaction producing moderate pain is 
experienced but this passes off within 


24 to 48 hours when the oil has been 
completely absorbed. The injection is best 
made through a two-inch spinal needle, and 
care should be exercised that the oil is not 
injected into the fascial planes or perios- 
teum as a sterile abscess may develop if 
these areas are invaded. 

The use of the drug by me in the treat- 
ment of arthritis is purely empirical, and 
no attempt will be made at this time to 
explain why it is beneficial in arthritic 
cases. Mention might be made of the 
active principles which are two, namely, 
hydrocarpic acid and chaulmoogic acid, 
these are unsaturated acids, (4) also that 
chaulmoogra oil stimulates leucocytosis. (5) 
Urinalysis shows acetone but this is believed 
to be a split up acid rather than true 
acetone. 

The use of the drug for the treatment of 
arthritis was first started by me in Febru- 
ary of 1930, and up to the present 39 
patients have been discharged from the hos- 
pital ; 29 of these were from my own service, 
and 10 from other services. All of the 
patients were in bad condition demanding 
hospitalization and most of them were con- 
fined to bed. No selection of cases was made 
other than that they were of the atophic, 
hyperthrophic, or the mixed type and diag- 
nosis was confirmed in most cases by roent- 
gen-ray. All foci of infection were investi- 
gated and cleared upon when possible 
especially chronic constipation. No atten- 
tion was paid to special diet. Without ex- 
ception every patient has shown improve- 
ment; many complete relief of symptoms, 
and restoration of function; others arrest- 
ment of the disease and reduction of de- 
formity. No patient has been readmitted 
to the hospital with a return of the con- 
dition. Thirty-nine patients have been dis- 
charged, and at present there are nine 
being treated in my service alone, and all 
are improving. The procedure is there- 
fore offered as the one method that has 
given me better results in the treatment of 
these conditions than all others. 


184 


McIlhenny — Chaulmoogra Oil in the Treatment of Arthritis 


Improvement may be expected during the 
second week of treatment ; the average 
patient becomes symptom free fin about 
eight weeks. 

The following cases were of the advanced 
type and are therefore cited: 

CASE REPORTS. 

Case 1. Mrs. R. H., white, aged 40 years, ad- 
mitted June 16, 1930, with combined or mixed 
type. Five years previous she began having pains 
in hands, knees, and ankles, later her shoulders, 
elbows and wrists became involved. When admitted 
she complained of pains in fingers and wrists, 
elbows, shoulders and knees, with increased fluid 
in wrists and knees ; fingers showed fusiform 
enlargement, knees were flexed. Had been treated 
with various anti-arthritic measures before coming 
to hospital, but had experienced no relief. Ques- 
tionable teeth and tonsils had been removed; con- 
stipated. Roentgenogram showed atrophic and 
hypertrophic arthritis. She was given bi-weekly 
intramuscular injections of 5 c.c. and 1.6 c.c. by 
mouth t.i.d. of chaulmoogra oil. Discharged on 
December 17, 1930 symptom free. 

Case 2. Mrs. M. J., white, aged 33 years, ad- 
mitted February 8, 1931, with atrophic type. 
Ha»ds and fingers swoolen and tender, fingers 
showed ulnar deviation; interossei and lumbrical 
atrophy; ankles, knees, elbows and shoulders also 
involved. Teeth had been removed; tonsils nega- 
tive; constipated. Was treated with chaulmoogra 

011. Discharged May 13, 1931, symptom free. 

Case 3. E. S., colored male, aged 38 years. 
Porter. Admitted November 21, 1930. Diagnosis, 
atrophic arthritis, chronic myocarditis. Complained 
of pain and stiffness in all joints. Similar attack 
three years previous to present illness. Examina- 
tion showed swelling and pain in fingers, wrists, 
elbows, ankles and knees, shoulders and hips also 
involved; knees and fingers flexed; could not flex 
or extend fingers; no edema, Wassermann nega- 
tive. Constipated. Treatment: Bi-weekly injec- 
tions, as well as by mouth. Discharged February 

12, 1931, with normal motions and no pain. Is 
back at work. 

Case 4. J. R., white, male, aged 45 years, ad- 
mitted February 27, 1931, with hypertrophic 
arthritis of lumbo-sacral, sacro-iliac and hand and 
wrist. Constipated; teeth and tonsils had already 
had attention; had had pain in back and left leg 
for four years; unable to extend leg or bend over, 
forced to lie on his side. Wassermann negative. 
Was treated with iodo-cincophen for five weeks 
without relief. After five injections of chaulmoo- 
gra oil and 1.6 c.c. t.i.d. by mouth he was able to 
be up, walking around. Was discharged M?” 


20, 1931, free of pain, and with almost normal 
motions; returned to work. 

Case 5. Miss R. S., white, aged 29 years, ad- 
mitted January 9, 1930, with advanced atrophic 
arthritis. Fingers, hands, elbows, shoulders, 
jaws, hips, knees, ankles and toes involved; 
fingers and toes showed flexion contraction; 
fibro-chondromata on dorsum of meta-carpal, and 
under elbow joints. Had been in my service for 
the same condition previously, and treated with 
amiodoxyl, benzoate, iodo-cincophen, guaiacol car- 
bonate and activin without relief; teeth and ton- 
sils had been removed. Was put on chaulmoogra 
oil February 4, 1930, and still under treatment. 
This is the most persistent case in this series. She 
has improved remarkedly, and from being unable 
to walk or use her hands or arms she is now up 
and about with no pain except when walking, when 
she has some discomfort in her ankles, this is 
thought to be due to the marked deformity of her 
ankles and feet rather than to the disease. The 
condromata have reduced in size and are not sen- 
sative; all points are normal and size and appear- 
ance except the fingers and toes. Continue* 1 , 
improvement and final arrestment is expected in 
this case. 

I am rather inclined to the opinion that 
treatment should be continued for some 
weeks after patients have become symptom 
free. 

REFERENCES. 

1. McIlhenny. Orthopedic Problems in Leprosy. Jour. 
Am. Med. Assn., 87:1888, 1926. 

2. Pharmaco-therapeutics. Soloman Solis-Cohen. 1928 
edition. 

3. Johansen. F. A. U. S. Public Health Reports. 
December 9, 1927. Reprint No. 1193. 

4. Potter’s Therapeutics -Materia Medica and Pharmacy. 

15 th edition. 

5. Wilcox. Materia Medica and Therapeutics. 12th 
edition. 

DISCUSSION. 

Dr. E. D. Fenner (New Orleans) : I regret 

that, in opening the discussion, I am not able to 
bring any very positive testimony as to the efficacy 
of this newest specific for chronic arthritis. My 
personal experience in the use of chaulmoogra oil 
began only a few weeks ago, and the number of 
cases upon whom I have been able to apply it is a 
small one. None of them, moreover, have been : 
under treatment long enough to either confirm the 
experiences related to the essayist, or to negate 
them. 

I confess that I am not quite so optimistic in 
regard to the results to be expected from the 
tre^tm^nt nf cbr«»\ 2 <» ntrophic, hypertrophic, and 


McIlhenny — Chaulmoogra Oil in the Treatment of Arthritis 


185 


mixed arthritis with chaulmoogra oil, as the 
essayist probably is. It is a universal experience 
that tthe inventor of an operation, or the discoverer 
of a cure, is likely to report better results than his 
colleagues do. Chronic arthritis has had more 
cures discovered for it than any other disease in 
the world, but most of them have been discarded, 
while chronic arthritis continues to torment and 
cripple thousands. A final verdict upon the value 
of chaulmoogra oil as a cure for chronic ar- 
thritis must, therefore, await a wider experience. 
But whether other men find it as efficacious 
as Dr. McIlhenny has or not, this is an exceed- 
ingly interesting contribution, because any one 
who discovers a remedy that will benefit even a 
fourth of the cases of chronic arthritis will have 
done a great deal for suffering humanity. 

I congratulate the essayist upon his original 
investigation, and I sincerely hope that experience 
will lead me and many others to a like confidence 
in its curative power. 

Dr. Youman (New Orleans) : I have not had 

much experience in the treatment of arthritis with 
chaulmoogra oil except for a few cases while on 
an orthopedic service. 

There were two cases of particular interest. 
One of the cases had bilateral hydrarthrosis on 
whom we had tried most of the accepted methods 
of treatment of arthritis, without result. I had 
heard Dr. McIlhenny praising chaulmoogra oil and 
decided to try it. I gave it to the patient as 
Dr. McIlhenny has outlined and, after six weeks 
of treatment, we sent him out of the hospital 
symptom free. I have followed his case up and 
he has remained symptom free since. The second 
case was a white female sixty-five years old who 
had been in the hospital for six months. We had 
been treating her by different methods without re- 
sult, so we used chaulmoogra oil on her and after 
eight weeks of treatment sent her home. I have 
not been able to follow this case up so I don’t know 
if the symptoms have returned or not. 

Dr. Isbel (New Orleans) : I have been for- 

tunate enough to work with Dr. McIlhenny for 
two months on his service. During that time we 
had about eleven cases we were treating. We were 
unable to obtain the chaulmoogra oil for about a 
period of ten days. During that time the patients 
could not receive their injections. There were two 
which had the hypertrophic type with a great deal 
of fluid in the joints and edema about the joints. 
During the period in which there was no chaul- 
moogra oil, they developed increased swelling and 
edema about the joints with increased pain, which 
was not reduced by salycilate or iodo-cincophen. 
When we got the new supply of chaulmoogra oil 
and were able to continue injections, the swelling 


went back to the point to which we had reduced 
it before the chaulmoogra oil gave out, and the 
symptoms receded. 

We had another case who came in with min- 
imum amount of disability, a patient we were un- 
able to keep in the hospital. He remained in the 
city about seven weeks to get his chaulmoogra oil, 
coming to our orthopedic clinic to get his injections 
twice a week. When he left, after six weeks, he 
was able to use his hands and go back to work. 

Dr. Davis (New Orleans) : When I took pver 

Dr. Mcllhenny’s orthopedic service at Charity 
Hospital as his interne, I had heard a lot about 
oxyl-iodide compound and how good it was in the 
treatment of certain types of arthritis. A case 
of hypertrophic arthritis of the lower lumbar 
spines was admitted to the service, so I imme- 
diately put him on this preparation. When Dr. 
McIlhenny saw the case, he allowed me to con- 
tinue the same treatment. After five weeks of 
extensive iodo-cincophin therapy, and a lot of 
persuasion toward improvement on my part, the 
patient was very little better, if any. 

He was then put on the usual chaulmoogra oil 
treatment and I’ll have to admit that, after two 
weeks of this, he showed definite signs of 
improvement. 

I handled with Dr. McIlhenny two of the most 
serious cases he has mentioned and I might say 
that, had it not been for a definite set-back due 
to vaccinia from smallpox vaccination on the part 
of one, she would have improved more steadily. 
The treatment was discontinued at this time. 

Throughout the whole service, I saw more of the 
cases than Dr. McIlhenny did, and I think I 
noticed even more improvement in the patients 
than he did, so I am ready to vouch for every- 
thing he has said. 

Dr. Moseley (New Orleans) : I am interested 

in chaulmoogra oil. I am interested in it not be- 
cause I am working with it, or have any immediate 
knowledge of it, but because of the contribution it 
seems to have made to medical science. 

From my casual reading of Roger Adams’" 
work on the determination of what might be called 
the active principles of chaulmoogra oil, I am 
rather interested to know whether the drug as 
reported by Dr. McIlhenny is the original chaul- 
mooerra oil, or if it may be one of the newer 
synthesized drugs emanating from the researches 
of Roger Adams of the University of Illinois; 
whether the oil you have used has been purified 
from all unnecessary and inert, though sometimes 
active, impurities, or whether it is the newly 
synthesized product which you have found ex- 


186 


McIlhenny — Chaulmoogra Oil in the Treatment of Arthritis 


tremely efficacious in the treatments described? 
Thank you. 

Dr. Edith Loeber Ballard (New Orleans) : Just 
recently I came across two cases of arthiritis de- 
formans. One was a man who had been incapaci- 
tated for twenty-five years, and the other, a boy 
nineteen years of age, just starting with the dis- 
ease, showing what seems to be an hereditary 
tendency. Is it possible to send these two cases 
to Dr. McIlhenny for assistance and some further 
treatment? If you would like them, you may have 
them. 

Dr. Boudreau (New Orleans) : I was on 

Dr. Mcllhenny’s service also for two months dur- 
ing which time eight cases were treated by the 
method discussed. Four of them were cases that 
were already being treated when I came on the 
service, and the other four I started treatment 
on. These last four were discharged, two at the 
end of four weeks and two at the end of six weeks. 
They were all much improved and able to carry on 
their work. The other four cases were far ad- 
vanced arthritis but showed some improvement 
during the two months of treatment. 

Dr. Joachim (New Orleans) : I feel very much 

like a liason doctor, bringing before this body a 
message on chaulmoogra oil. 

At a recent meeting of the ear, nose and throat 
association, one of our prominent eye doctors as- 
sured us that chaulmoogra oil, sprayed in the nose, 
was of benefit in eye and nasal pathologic con- 
ditions of chronic inflammatory nature. This is of 
great importance if based on accurate observation. 

Chaulmoogra oil in these conditions is recom- 
mended to be used in dilution with oil derived from 
the sunflower seed. 

Chaulmoogra oil is coming into greater use than 
ever before and, if these reports turn out to be 
"based on facts, it will be an important addition 
to our therapeutic resources. 

Dr. T. J. Dimitry (New Orleans) : It was I 

who read the paper on the effect of chaulmoogra 
oil in eye and nose conditions at the Eye, Ear, 
Nose and Throat Club some months back, as re- 
cited by the doctor who has just spoken. 

I have been very much interested in this thera- 
peutic agent and I have been hunting for an ex- 
planation of its beneficial effect. My whole work 
is still experimental and my contribution merely 
recited facts. 

I compliment Dr. McIlhenny in his work and I 
feel certain that he is accomplishing a good in 
the condition recited. I feel that before very long 
the “why” will be explained, but we must be watch- 


ful in reciting the many beneficial effects and 
control rigidly any statements. The latter is the 
reason for my delay in publishing more upon the 
subj ect. 

Dr. Webb (New Orleans) : It would be futile 

on my part to attempt to add anything to what 
Dr. McIlhenny has said, but I am on his service 
at the present time and have been associated with 
him for six weeks. We have treated sixteen 
patients since I have been associated with Dr. 
McIlhenny and four of these patients remain in 
the hospital now. 

There are some who are coming from Lockport 
and Thibodaux and other towns over the state who 
have been materially benefited and so much so that 
they come regularly twice a week for their injec- 
tions. They have both the hypertrophic and 
atrophic type. Some could hardly walk when they 
came in. All of them have been materially 
benefited. However, some of the results are not 
very good but we see some improvement. 

One thing has not been brought out. You have 
to be very careful in giving these injections be- 
cause you sometimes get abscesses. We have had 
a few of these. It seems to be very irritating, 
probably due to the fault of the man gives it and 
probably due to the olive oil that we have used 
that was not the purest type. I find most of the 
cases are greatly benefited with chaulmoogra oil. 

Dr. DeMotte (New Orleans) : We are using 

the chaulmoogra oil treatment in the clinic as well 
as on the wards. Patients, of necessity, have to 
be taken out of the hospital before they are cured, 
and sent to the clinics over a long period of time, 
and we find we can use the chaulmoogra oil there 
and adequately follow up the cases. We have been 
using it for the past month and of the few cases 
that have come into our service, there are two 
which have shown very definite improvement. 
These two were on salicylates, but were taken off 
the latter and chaulmoogra oil used alone intra- 
muscularly and orally. 

Two arthritis cases in the hospital in our service 
seem to have presented more or less of a thera- 
peutic problem, both of the hypertrophic type. 
One had salicylates on the outside and salicylates 
in the hospital for two weeks without much relief 
of the joint symptoms. We gave chaulmoogra oil 
orally and intramuscularly and really a remark- 
able transformation resulted. He became practi- 
cally another man. He helped around the wards 
and had notably a better disposition. I have not 
heard from him since his discharge. Another case 
of interest was a man that came in about the same 
time. While he showed definite improvement in 
the hospital, on being discharged about three weeks 
ago, he has now returned because he has the sair r 


Kibbe — Undulant Fever: A Public Health Problem 


187 


symptoms with which he came in initially. He did 
not have at home the benefit of chaulmoogra in- 
jections. After being’ in the ward for a week and 
having two injections, he is feeling much better. 
Both men reminded me when it was time for their 
injections — in spite of the discomfort that follows 
them. 

Dr. Mcllhenny (closing) : I have very little to 

add to what I mentioned in my paper. 

In reply to Dr. Moseley’s question about crude 
oil, this is, so far as we know, the crude oil as put 
out by Parke, Davis and other drug firms or 
wholesale manufacturers. It is the crude oil that 
is being used at the National Leprosarium. It is 
not hydrocarpate or the chaulmoograte, or any of 
the ethyl esters, it is pure, crude oil, mixed with 
olive oil and benzocaine, filtered and sterilized. 

It might be of interest to state that in discuss- 
ing the question of the value of chaulmoograte or 
the hydrocarpate or ethyl esters with Major Denny, 
Commandant at Carville, in connection with my 
experiment in arthritis with crude oil, he said that 
he was not at all convinced that there was any 
value in the ethyl esters as compared to crude oil. 
He feared when reducing to the ethyl esters they 
lost a great deal that was possibly beneficial in 
the crude oil, so he preferred the crude oil in the 
treatment of leprosy to the other preparations. 

I am rather inclined to his idea. Since crude 
oil, if given in proper doses, does not cause any 
great amount of pain, since, if an abscess forms, 
it is a sterile abscess which, when evacuated, gives 
no further trouble, since it has not any deleterious 
action on any organ of the body, since patients bear 
it very well, since they do respond to the treat- 
ment and, if nothing more, are relieved of their 
pain, I am rather inclined to take his advice and 
use a crude oil. 

I have had no experience with the refined 
product. 

In reply to Dr. Loeber-Ballard’s question about 
referring cases she has mentioned to our service, 
from the description of the first case, I judge, 
possibly, we might hold out some hope to that in- 
dividual. Although we may not expect to get 
restoration of function in joints already affected, 
we could expect reduction in symptoms and relief 
of pain. 

With reference to the second case, where ar- 
thritis is already established bnt not so far ad- 
vanced, I think we could restore considerable 
function. 

In the third case, where arthritis has just 
begun, we might be able to arrest it absolutely. 


I am possibly leaning too much to the optimistic 
side but I have not yet seen a case that has not 
improved, and have not had a case returned to the 
hospital for a second course of treatment. 

Through the courtesy of the Parke, Davis people 
we will soon be able to get this drug put up in 
enteric capsules, and they have advised me a sup- 
ply will shortly be coming so I can give it here 
at the hospital. The preparation has to be put 
up rather carefully and it requires some forty- 
eight hours to put it through the necessary pro- 
cesses. If the demand for it warrants, I believe 
we can arrange to have it put up in sterile con- 
tainers so it can be available almost anywhere. 

UNDULANT FEVER— A PUBLIC 
HEALTH PROBLEM.* 

P. A. KIBBE, M. D. 

New Orleans 

A complete description of undulant fever 
in all its phases is not at this writing possi- 
ble. However, as it belongs in the domain 
of public health, the knowledge we have is 
important to those who are even remotely 
concerned with the education of the people 
in the means of health protection. 

In the medical history of fevers, we find 
reference to the “protracted” fevers of the 
time of Hippocrates. Whether it was this 
type we have no definite evidence. But in the 
eighteenth and early nineteenth centuries 
many records tell of the fever occurring on 
the Island of Malta. In 1859 Marston gave 
a fu 7 l and accurate account of “Mediter- 
ranean remittent” or “gastric remittent 
fever.” Thus between 1860 and 1870 un- 
dulant fever became a distinct clinical en- 
tity. In 1887, Surgeon Bruce demonstrated 
the etiological agent of the infection. He 
cultivated the causal organism and repro- 
duced the disease in experimental animals. 
It was about this time — 1904-1917 — a com- 
mission was appointed on which were rep- 
resentatives of the Army, the Navy and the 
Civil Government of Malta. The detailed 
and laborious studies of the Commission de- 
termined the nature of the infective organ- 
ism. They demonstrated that the “micro- 
coccus leaves the body mainly through the 

*Read before the Louisiana State Medical So- 
ciety, New Orleans, April 14-16, 1931. 


188 


Kibbe — Undulant Fever: A Public Health Problem 


urine; that goat milk agglutinates the or- 
ganism.” Also that the “germ was isolated 
from such goats although the organism did 
not seem to affect injuriously such animals, 
even when they lived in the blood stream 
and were secreted in the milk.” The source 
of the discovery was almost an accident. 
Small laboratory animals being unavailable, 
six goats were purchased for experimental 
purposes. That the animals were naturally 
infected was soon proved. It was then a 
simple matter to show that goats were the 
common source of infection. 

In this country in 1904, Craig established 
the diagnosis of a case in a nurse who had 
never been out of the United States. He 
then suggested that many cases supposedly 
atypical typhoid were really undulant fever. 
In Arizona, a goat raising area, in 1922, 
there was an epidemic which gave oppor- 
tunity for study and experiments. 

As far back as 1896 Bang discovered the 
casual organism Bacillus abortus. He did 
not suspect the relation between the organ- 
ism he had discovered and that of Bruce. 
A comparison followed and the etiological 
agent of contagious abortion in cows was 
determined. Miss Evans made an impor- 
tant contribution when she proved that 
morphologically, culturally, bio-chemically 
and by simple agglutination test, the Mi- 
crococcus melitensis and Bacillus abortus 
were indistinguishable. 

It was then accepted that Malta or un- 
dulant fever may be caused by the Brucella 
melitensis of goats, the Brucella Bang of 
cattle and the Brucella Traum of pigs. 

There are three varieties of the meliten- 
sis and two distinct types of the variety — 
abortus — bovine and porcine. 

The disease appears in sub tropical and 
temperate climates. It is known to exist in 
Russia, Italy, France, East and South Af- 
rica, North and South America and in the 
West Indies. Infectious abortion of cattle 
also occurs widely in all stock raising coun- 
tries. 


In the calendar year of 1929, 975 cases 
were officially reported to the U. S. P. H. 
Service with forty-one deaths. The 1929 
distribution was seasonal the number of 
cases increasing to September after which 
there was a sharp drop. 

The disease had been made reportable in 
many states. In Louisiana it was added to 
the reportable list in March, 1929. Seven- 
teen (17) cases were reported that year and 
twenty (20) in 1930 with two (2) deaths 
each in 1929, 1930, directly charged to this 
disease. 

The large number of cases in the U. S. 
focused attention upon the apparent cause 
and investigations to show the possible viru- 
lence of the different varieties were given a 
new impetus. One of the most thorough 
and detailed of these was conducted in Porto 
Rico. The records and results were pub- 
lished in the Porto Rico Journal of Public 
Health and Tropical Medicine in the Sep- 
tember issue of 1930. 

The range of experiments is of interest. 
Blood serum was examined for abortus 
from 10 per cent of the entire number of 
animals. The seventy-nine dairies supply- 
ing milk to San Juan were visited. Of 528 
samples, 312 were positive, a total of 58 
per cent positives. All herds examined ex- 
cept six, had reactors among the samples 
taken. It may be well to add here, data 
gathered in Illinois, where tests were given 
of more than 5000 cattle distributed over 
35 counties, show that one of every five ani- 
mals is a reactor to the aggluntination tests. 

Vaccination against bovine contagious 
abortion was tried. Living and dead cul- 
tures were used. The conclusion was “vac- 
cination with living cultures is superior to 
the dead culture injection and that it re- 
duces the number of abortions occurring in 
infected herds.” Further study is recom- 
mended under competent research spe- 
cialists. 

Transmission experiments were tried on 
human subjects and animals. From these 


Kibbe — Undulant Fever: A Public Health Problem 


189 


“it seemed infection took place more read- 
ily through abraded skin than through the 
gastro-intestinal tract.” Infection through 
unabraded skin was not accomplished but 
further attempts with larger doses should 
be tried. 

Of fifty cases inoculated by various 
methods only ten contracted the infection — 
six through abraded skin, four through the 
gastro-intestinal canal. Of the six infected 
through the skin, three were inoculated with 
bovine, one with melitensis and two with 
porcine strains. The significant fact is a 
single dose was enough to produce in these 
cases infection. Of the four inoculated 
through the intestinal tract porcine strains 
were used with two, melitensis with one and 
one with a bovine strain. Two or more 
doses of the porcine were required and sev- 
en consecutive doses of the bovine to pro- 
duce a mild case with the bovine strain. A 
single dose only produced infection with the 
melitensis strain. “We are therefore under 
the impression that only the most virulent 
bovine strains, when ingested in sufficient 
doses are of danger to man.” Smaller 
doses through abraded skin will cause in- 
fection. 

This result accounts for the number of 
cases that occur among farmers, laboratory 
workers, veterinarians and packing house 
employees. Persons engaged in these occu- 
pations make up about 40 per cent of the 
cases in the United States. 

Undulant fever, in severity and duration 
of symptoms, may be divided into four 
types : 

1. Fatal. 

2. Severe or moderately severe. 

3. Mild. 

4. Ambulatory — the types are also given 
as the malignant, the undulatory and the 
intermittent. 

The symptoms — generally — of each type 
is as follows : 


Intermittent : Onset insidious, afternoon 
weariness; general aching; some headache, 
a distaste for food, chilliness in the early 
evening and moderate insomnia and some- 
times a suspicion of fever. Backache, stiff- 
ness or pain in the neck and joints, consti- 
pation and loss of weight — later, night 
sweats and repeated rigors. With mild in- 
fection, the patient may be up in the morn- 
ing but glad to rest in the afternoon. 

Ambulatory : All symptoms of the inter- 

mittent type, though mild in degree — the 
usual symptoms frequently the only one be- 
ing weakness or lack of endurance — temper- 
ature normal in the forenoon, rarely 101° in 
the evening. 

Undulatory : Distinguishing characteris- 
tic, occurrence of relapses — equal in sev- 
erity the milder and moderately severe in- 
termittent form. 

Malignant : Sudden onset, high temper- 

ature with an extreme hyperpyrexia before 
death, great prostration, severe headache 
and backache, marked anorexia, and usually 
true rigors and constipation, delirium and 
coma. 

Intermittent type duration — six weeks to 
four months — sometimes prolonged — infec- 
tion terminates fatally. 

Ambulatory — duration — varies from two 
weeks to several months, often more than 
one month and less than four. 

Undulatory — duration — uncertain. 

Malignant — duration — about three weeks. 

Undulant fever may present the clinical 
manifestations of typhoid fever, tubercu- 
losis, bronchopneumonia, meningitis, cys- 
titis, rheumatism and various surgical 
conditions. 

Although there is a general optimism 
concerning bovine infection, it is gratifying 
that the eradication of this specific organ- 
ism is a probability in the near future. 
Since January 1, 1931, in Louisiana, more 
than 65,972 cattle have been tested for 


190 


Kibbe — Undulant Fever: A Public Health Problem 


tuberculosis. The abortus test has also been 
given in some instances. Few cattle have re- 
acted to either. By the middle of July, 1932, 
the work will be completed and our people 
will be largely protected from these milk- 
borne disease. 

There are wide differences of opinion as 
to the causative agent of the disease in our 
own country. In 1929 King and Caldwell 
expressed the opinion “that raw milk in- 
fected with Brucella abortus produces 
agglutin and causes undulant fever in man.” 

In a splendid symposium on this subject 
at the 1929 meeting of the American Pub- 
lic Health Association it was stated “our 
study of the disease shows clearly that B. 
abortus is only slightly pathogenic for 
man and it must be that only most virulent 
strains in milk are of danger to him.” 
(Carpenter and King.) 

It is thought by some — notably Orr and 
Huddleston — who have studied the epidem- 
iological aspect in Michigan, that “among 
the human population susceptibility to in- 
fection B. abortus, bovine type is very low 
and that human infection is determined by 
some factors yet undetermined.” It is this 
element which makes a complete resume of 
the subject impossible. But we realize the 
extent of the infection ; we know something 
of the factors ; we know the symptoms ; we 
are warned diagnosis is not easy — for these 
reasons it is wise and pertinent to keep un- 
dulant fever in mind. 

Study of improved methods of diagnosis 
and treatment ; investigations of the several 
yet undetermined factors which appear for 
example in many places where there is a 
high percentage of cattle infection there is 
a low human incidence of the disease and 
complete clinical and epidemiological 
records are specia^y pertinent and will 
be helpful in pointing the way toward 
control and final eradication of undulant 
fever — now unquestionably a public health 
problem. 


DISCUSSION. 

Dr. J. M. Bodenheimer (Shreveport) : Dr. 

Sandige has asked me to be a pinch-hitter this 
morning for the simple reason that I have had a 
little experience in the treatment of undulant fever. 
There have been four cases reported in Caddo 
Parish. Three have been in my private practice, 
the fourth I have seen in consultation. Of the 
different types of cases, we have seen the acute 
fulminating type and we have seen the ambulatory 
type, and the other cases have ranged between 
the two. 

One of my reasons for coming down here to 
this meeting was to find out how to cure undulant 
fever. I expected Dr. Kibbe to tell us something 
along this line, and I hope some of those who will 
discuss this disease, following me, will tell us how 
to cure the disease. I used mercurochrome in- 
travenously in 1 per cent solution, and the patients 
reacted very favorably to this treatment in three 
of the cases. 

The fourth case, which I now have under treat- 
ment, has been sick for something like ten weeks, 
and she is still running a temperature and is still 
in bed, for the simple reason that I don’t know 
what else to do with her. We tried the mercuro- 
chrome treatment without any effect. I read in 
Clendening’s latest edition that his friend Fred 
Angle had a vaccine with which he had cured 
twenty cases, and so I sent up to Kansas City and 
got some of this vaccine and I gave this lady a 
dose of it. After two weeks’ time she still swears 
it was meant for a cow and not for her. The re- 
action is tremendous. Dr. Angel says he gives 
four doses, four days in succession, but all I can 
say is that the fortitude of the people around 
Kansas City is much greater than the fortitude 
of those around Shreveport because the prostration 
was so severe it was impossible to induce the 
patient to take the second dose. 

One of the things that impresses me very much 
about undulant fever of the ordinary type, is that 
the patient just has fever and is not sick. There 
are practically no diagnostic physical signs. This 
case that I still have under treatment and that 
I have watched very closely and have done a lot 
of laboratory work on, is apparently in as good 
health at the end of ten weeks as she was in the 
beginning of the treatment. About a week ago we 
made a routine blood examination and we found 
that her blood cells were 4,500,000, and hemoglobin 
was 80 per cent. 

One of the curious things about this disease is 
that after all that length of time she doesn’t seem 
to have anemia. I notice most writers on the sub- 
ject say there is a mild form of anemia in these 
cases. 


Abramson — Tattooing : Review of Its History and Methods of Removal 191 


The symptoms of the disease that impress me are 
the profuse night sweats, insomnia, and loss of 
appetite. I say there are no physical signs — noth- 
ing that you can put your hands on. The symptoms 
are almost entirely subjective. This last case is a 
very intelligent woman and she watches her con- 
dition closely and keeps notes on it, and I have 
been able to learn a good deal from her case alone. 
I promised her when I came down here I was 
to bring something back to free her of the fever. 

I notice that most of the textbooks and most of 
the writters (I say writers because there is very 
little in the textbooks) say that the disease will 
wear itself out. I doubt this very seriously. One 
of the first cases I treated had been under obser- 
vation for seven years, and had been to bed at 
least three times under treatment for tuberculosis. 
That is one point I want to make. I think there 
are a lot of cases of these so-called cured cases of 
tuberculosis — these border line cases that go to bed 
for three months and then get up — that are really, 
if the investigation is carried out more fully, un- 
dulant fever cases. If you observe these cases 
carefully — at least it observed in these three or 
four cases that I have treated — from time to time 
you can hear a few rales scattered about through- 
out the lung, and with a little rise of temperature, 
if you are not thinking of undulant fever, you will 
certainly be suspicious of tuberculosis. Even if you 
have an roentgen-ray taken, it is a very poor 
roentgenologist who can’t help a friend out and 
find a little spot if that friend has a case he hasn’t 
been able to diagnose. 

To sum up, I think there are a lot of cases of 
undulant fever scattered throughout Louisiana and 
other parts of the South, and other places for that 
matter, that have remained undiagnosed, and I 
think if we begin to study this disease more fully 
and know more about it we are going to report a 
great many more cases than we are reporting 
today. I know that right in my practice now I 
have several cases I haven’t been able to prove, 
and I feel satisfied we will prove them eventually. 
We hadn’t reported any of these cases as undulant 
fever until the State Board of Health pronounced 
them undulant fever. We have gone further and 
sent the blood to the Hygienic Laboratory at Wash- 
ington for confirmation. When we get a slight 
agglutination in our private laboratory we are not 
going to call it undulant fever. As I said before, 
I believe there are going to be many more cases 
diagnosed as we learn about the disease. 

Dr. M. D. Hargrove (iShreveport) : I have 

nothing new to add to the knowledge of undulant 
fever but wish to report two rather interesting 
•cases. One, a lady in Shreveport, who last summer 
made a trip into old Mexico, staying about three 


days, but during that time used goat’s milk. She 
came home and in about two or three week’s de- 
veloped temperature. We thought it was malaria 
or typhoid and everything else before it ever 
dawned on us that it was undulant fever. Her 
blood was positive for the melitensis. She got well 
without any treatment at all, practically speaking; 
nothing that did the fever any good. 

Another patient with undulant fever of the 
abortus type had been running temperatures for 
about six or eight weeks, with slight remissions 
during that time. We treated him in a similar 
way, giving him nothing in particular. Finally, 
we decided that perhaps it would be well to 
try mercurochrome, and gave him one injection 
10 c.c . — Vz per cent. His temperature went to 
normal within twelve hours and remained normal. 

I am not a very ardent believer in the value of 
mercurochrome, but it would seem that it had some 
effect in that particular case. 

Dr. P. A. Kibbe (New Orleans) : I want to 

thank the doctors for their discussion. 

I am awfully sorry I can’t give Dr. Bodenheimer 
a cure for undulant fever. I think the treatment 
is mostly symptomatic, and the duration is from 
two weeks to months. 


TATTOOING— A BRIEF REVIEW OF 
ITS HISTORY, PATHOLOGY AND 
METHODS OF REMOVAL. 

PAUL D. ABRAMSON, M. D., 
Shreveport, La. 

Tattooing is the introduction of pig- 
mentary matter into the skin, usually in- 
tentionally and in a definite design, but 
sometimes the result of accidental penetra- 
tion as following a gun explosion at close 
range. Its interest to physicians is mainly 
two-fold : first, because of the occasional 
complications which are attendant upon 
the application of the tattoo, and secondly, 
not infrequently the problem of tattoo re- 
moval is presented to the physician. In 
addition, tattooing very occasionally finds 
a legitimate use for cosmetic purposes or 
after plastic operations. No doubt there 
would be many more opportunities to re- 
move tattoo marks if the idea were not so 
prevalent among the profession as w T ell as 


192 Abramson — Tattooing: Review of Its History and Methods of Removal 


among the laity that these marks are per- 
manent and practically ineffaceable, or 
only removable at the expense of an ex- 
tensive and mutilating scar. As a mat- 
ter of fact, most such marks wherever 
placed are amenable to removal with a 
minimum of scarring. 

The word “tattoo” is in reality a Tahi- 
tian word “tatu,” derived from “ta” mean- 
ing “mark.” It was among these Polyne- 
sians that the art of tattooing reached 
some of its highest development. The 
exact origin of this peculiar onanistic cus- 
tom is uncertain and lost in the dim realms 
of antiquity. According to Shie, however, 
its incipiency was probably from the an- 
cient custom of slashing oneself as a token 
of grief over the loss of a tribal chief or 
a loved one. Those marks into which ashes 
(carbon) were accidentally introduced 
were found to be more permanent than the 
others, and gradually the custom arose of 
deliberately placing pigmentary matter 
(at first carbon) into these cuts in order 
to make a permanent record, as it were, of 
some previous grief. Death always hav- 
ing been closely intermingled with relig- 
ious beliefs, it was but a natural step for 
these markings to assume a religious sig- 
nificance. Gradually, instead of aimless 
slices about the body, the marks were 
made with some definite design or em- 
blem, and thus we have the first definite 
tattoo as it is known today. 

Although tattooing in its beginning 
probably had more of a religious signifi- 
cance than anything else, it is interesting 
to note that it was prohibited under 
ancient Mosaic Law (Leviticus XIX, 28). 
Soon the various peoples who were prac- 
ticing tattooing found other uses for it. 
Painting the face and body as an aid in 
warfare, to frighten the adversary, dates 
back to remote antiquity. With the ad- 
vent of tattooing, tattoo marks replaced 
part of this warlike array. Gradually cer- 
tain marks became distinctive of tribes 
and even individuals. In New Zealand, 
for example, tattooing of the face or 


“making the moko” as it was called, 
reached an extremely high degree of indi- 
viduality and no two faces were alike ; 
and these mokos served as a mark of dis- 
tinguishment. On the purchase of land in 
New Zealand from the natives in 1815, the 
mokos of the chiefs were copied by them 
as their signatures to the deed. 

As civilization has advanced, the prac- 
tice of tattooing has fallen from one of 
dignity and significance, to one practiced 
by charlatans and street fakirs upon 
gullible and frequently irresponsible (at 
the time) individuals. Nowhere has it 
reached the peak of development which it 
did in the Islands of the southern Pacific 
(Polynesia) and Japan. In ancient days 
this practice was an honorable calling 
handed down from father to son, but now 
the “tattooer has lost his caste, and tattoo- 
ing its art.” 

In modern times tattooing is usually 
seen in sea-faring people or in individuals 
who are tattooed under the influence of 
alcohol or in a spirit of bravado. Not 
only has the purpose and significance of 
these marks changed, but likewise have the 
methods. At first it was accomplished by 
the rubbing of pigment into open cuts; 
then there came the use of bodkins or 
chisels composed of bone or steel, and mal- 
lets : specimens of these have been found 
in the most ancient Egyptian tombs, these 
instruments usually being shaped like a 
little hoe. From these methods there 
gradually evolved the use of the needle, at j 
first hand-operated, but later, in modern i 
countries, electrically run. 

Tattooing has been quite a widespread ! 
custom, having been found in practically J 
every civilized and in most uncivilized ! 
countries, and presumably its origin has i 
been similar in each instance. However, i 
in certain places it is absent, either as the ! 
result of unfavorable legislation, or be- I 
cause of some superstition. Thus in Rus- j 
sia, according to Witthaus and Becker, | 
until comparatively recent times, tattoo- 
ing was found only in the prison camps ; 


Abramson — Tattooing : Review of Its History and Methods of Removal 193 


of Siberia because it was regarded as a 
mark of alliance with evil spirits. In 
Cleveland, the practice is prohibited by 
law; in Norfolk and in San Francisco it is 
subject to strict regulation. In other 
places, while the practice of tattooing is 
not subject to legislation, the removal of 
tattoo marks is construed as belonging to 
the realm of medical practice. In Japan, 
the practice has been prohibited for a 
number of years, and likewise the French 
government is said to prohibit it amongst 
its enlisted men. Tattooing has at times 
been used as a mark of identification, or 
for the branding of a criminal, this having 
been practiced in ancient Rome. At one 
time, a bill was almost passed by the 
French legislature to mark all new-born 
infants as a method of permanent identifi- 
cation. 

The pigmentary substances (carbon, 
india ink, indigo, mercuric sulfide, red 
lead, etc.,) used in tattooing are intro- 
duced not only into the stratified layers of 
the epidermis, but into the superficial lay- 
ers of the corium as well. Apparently the 
pigment is carried into the layers deeper 
in the corium by the action of phagocytes, 
and the pigment can at times be recovered 
from adjacent lymph nodes. Most of the 
colors, unless treated, are permanent. It 
is said, however, that professional tattooed 
people are re-tattooed every ten years in 
order to keep the colors bright. That they 
are quite permanent is evidenced by the 
fact that tattoo marks have been found 
on Egyptian mummies dating from 4000 
B. C. 

Tattooing has other uses than for purely 
ornamental purposes. In surgery it has 
been used to obscure certain facial blem- 
ishes or to color lips after cheiloplastic 
operations. It is said that on the West 
coast permanent rouge or lip stick is 
tattooed into the cheeks or lips as the 
case may be. 

Complications arising from the applica- 
tion of tattoo marks are not nearly as fre- 
quently seen since the introduction of 


modern methods of tattooing as they were 
formerly. The abandonment of the prac- 
tice of rubbing saliva, urine, and what not, 
into the marks to make them “take” ; and 
the preparation of the field before tattoo- 
ing has been a large factor in the reduc- 
tion of the morbidity. Some idea of just 
how much trouble used to result from this 
practice is indicated by the report of Ber- 
cheron’s published in 1862. He reported 
43 cases in which 8 deaths occurred as a 
direct result of tattooing; in 8 others, an 
amputation was necessary; in 25 others 
there was marked inflammation and in- 
fection. The types of infection resulting 
from tattooing have varied from a simple 
localized inflammation to septicemia and 
death and have included such infections as 
leprosy, tuberculosis and tetanus. In some 
localities, so many cases of syphilis have 
been transmitted by a tattooer that a 
tattoo mark has been considered as tanta- 
mount with a leuetic infection. 

There have been innumerable methods 
advocated for the removal of tattoo marks, 
indicating, obviously, that no method is 
entirely satisfactory. Thus Cattani has 
enumerated thirteen distinct procedures 
designed for the effacement of these pig- 
mentary deposits including simple blister- 
ing, the use of carbon dioxide snow, use of 
mother’s milk, Finsen rays, digestion with 
papain, cold cautery, etc. However, of all 
these methods advocated there are only 
three types of de-tattooing that are of any 
great value, viz.: (1) surgical, (2) elec- 
trolytic and (3) chemical. Each method 
has its exponents and probably there is 
some value in each of these methods. 

The surgical procedures consist largely 
of either excision of the entire tattoo mark, 
suturing the skin edges together, or skin 
grafting the area ; or of removing the 
superficial layers as in making a Thiersch 
graft, thus exposing the pigment so that 
it can be picked out ; or by dissecting up a 
flap containing the pigment, picking out the 
particles and sewing the flap back in place 
(harpooning method of Wederhakein) . The 


194 Abramson — Tattooing: Review of Its History and Methods of Removal 


two latter are too time consuming to be of 
much practical value and the former has 
definite limitations depending upon extent 
and location of the tattoo. 

Keller and Miller have been proponents 
of the electrolytic method: a 2-3 milliam- 
pere galvanic current is used, the needle 
being connected with the negative pole, the 
softening action of the alkali on the tissues 
permitting removal of the pigment. Cat- 
tani found the method unsatisfactory, re- 
quiring numerous applications and uncer- 
tain in its results. 

Numerous chemical methods have been 
advocated but of these there is one that is 
predominantly useful and, according to re- 
cent writers, is the best method of all for 
the routine removal of tattoo marks. This 
is the French tannic acid-silver nitrate 
method first advocated by Variot and mod- 
ified by Shie. Since Shie’s report in 1928, 
Korb (1929) has reported its use in 28 
cases : he removed the design completely 
in 8 cases; in 12 only a small amount of 
deeply placed pigment remained, and in 8 
there was incomplete removal. In all there 
was only a minimal amount of scarring and 
he was well pleased with the method. 

Briefly, this method is as follows: the 
area to be de-tattooed is prepared as for a 
surgical operation. Then using 50 per cent 
tannic acid, the entire area is re-tattooed 
using either a regular tattoo needle, or a 
short piece of % inch brass tubing into the 
slightly flattened end of which are soldered 
10 fine needles ; or simplest of all a cork may 
be used into one end of which is embedded 
10-15 fine needles. This re-tattooing is 
done through a layer of tannic acid which 
is kept on the mark while the tattooing is 
in process, replenishing as necessary. When 
the operation is completed the entire area 
is closely covered with needle marks and the 
pigment is almost obliterated by a grayish 
tint and by numerous fine droplets of blood. 
The excess tannic acid is then removed 
from the surrounding area by washing in 
cold water. Sterile vaseline is then placed 


on the skin around the tattoo marks as a 
protection to the normal skin during the 
next step. A stick of silver nitrate is then 
rubbed vigorously into the area thus mark- 
ed out causing a heavy deposit of silver 
tannate in the corium. The vaseline is then 
removed and the area washed with cold 
water. A dressing of tannic acid or a sim- 
ple sterile dressing is then applied. No 
anesthesia is required for this procedure as 
the patients do not object after a little tan- 
nic acid is tattooed in. The tattooing is 
carried to % inch beyond the area of the 
original tattoo mark. In about 12 hours 
the area becomes hard and leathery and all 
protective dressings may be abandoned. In 
14-16 days this black covering comes off, 
leaving a pinkish area which gradually be- 
comes white, and resulting in scarring that 
is scarcely noticeable. This method is appli- 
cable for the removal of accidental (e. g. 
gunshot) as well as intentional tattooing. 
If necessary, the process may be repeated 
to remove any areas not completely de- 
tattooed. 

SUMMARY AND CONCLUSIONS. 

(1) Tattooing is an ancient custom 
which through the ages has changed both 
in significance and in methods of applica- 
tion. 

(2) The pigmentary particles are, in 
part, introduced into the true skin, or 
corium; hence the usual indestructability 
of the tattoo marks. 

(3) Numerous methods of tattoo-re- 
moval have been recommended, of which 
there are three principal types, viz. : (a) 
surgical, (b) electrolytic and (c) chemical. 

(4) Of all these various methods, the tan- 
nic acid-silver nitrate method, originated 
by Variot and modified by Shie, is probably 
the simplest and most effective method for 
general use. 

BIBLIOGRAPHY. 

Cattani, P. : Tattoo marks and their removal, Schwzrsch. 

Med. Wchnschr., 51:128, 1921. 

Crocker, H. R. : Diseases of skin, P. Blakiston’s Son &- 

Co., 1905. 


Irwin — Address of Welcome on Behalf of the Local Profession 


195 


Encyclopaedia Brittanica, 11th edition, pp. 451-52. 

Korb, J. V. : The removal of tattoo marks, U. S. Naval 

Med. Bull., 27:674-77, 1929. 

Medical Record: Removal of tattoo majks, 99:923-24, 

1921. 

Miller, C. C. : Electrolysis for the removal of tattoo marks, 
Med. Council, Phila., 13:374, 1908. 

Ibid: Excision of tattoo marks, Am. J. Surg., 39:121, 

1925. 

Shie, M. D. : The art of tattooing and the science of 

tatoo removal, Hygiea, 632, 1927. 

Ibid : A study of tattooing and methods of its removal, 

J. A. M. A., 90:94-99, 1928. 

Stern, K. : The removal of tattoo marks, Munch. Med. 

Wchnschr., 60:2731, 1913. 

Van. Mesdag, S. : Destruction of tattoo marks, Nederlands 
Tijdschr voor Geneeskunde, 2:1289, 1919. 

Witthaus and Becker: Medical Jurisprudence and Toxi- 

cology, Wm. Wood & Co., 2nd edition. 


ADDRESS OF WELCOME ON BEHALF 
OF THE LOCAL PROFESSION.* 

EMMETT IRWIN, M. D.,f 

New Orleans. 

Mr. President: 

Today, you the members of a great Med- 
ical Society, the representatives of a be- 
loved and honored profession are the guests 
of the Orleans Parish Medical Society. It 
is an extreme pleasure and happy privilege 
for the members of the medical profession 
of New Orleans to be your host. 

It is only fitting that you should assem- 
ble each second year in New Orleans for 
this City is one of the prized possessions 
of the people of Louisiana. It belongs to 
you as to us, in the same manner as the 
profession of New Orleans is a part of 
you and you a part of it, — all working in 
harmony and unison for the promotion of 
the health of the people. 

The physician occupies a highly impor- 
tant position amongst his fellow citizens 
and they look to him with regard and re- 
spect. His place is quite unique in this 
life of strife and turmoil. It is to him his 
patient unfurls the sacred secrets of the 

*Read before the Louisiana State Medical 
Society, New Orleans, April 14, 1931. 

•{•President, Orleans Parish Medical Society. 


innermost recesses of the heart with a feel- 
ing somewhat of relief, and at the same 
time with a profound confidence their 
secrets shall not be revealed. Think, then, 
Gentlemen, of this lofty and exalted level 
to which our profession carries us and I 
wonder how often does one ask himself, 
“Do my actions as a man and in my pro- 
fession justify such degree of respect and 
confidence?” However, if a man is honest 
with himself to the degree of a sincere and 
satisfied conscience, then he need not fear 
for his fellow men will have been likewise 
satisfied in the deeds which he has per- 
formed — when he has done his best, he 
has done well. 

One of the great problems in Medicine 
today is the prevention of disease and the 
public must be made conscious of the ex- 
treme necessity of keeping their bodies 
in good physical condition through fre- 
quent periodic physical examinations. In 
this way early and incipient disease is de- 
tected when in a curable state rather than 
in the final and hopeless stage. For the 
past several years the Orleans Parish Med- 
ical Society has sponsored a Longer Life 
Week during which an educational pro- 
gram has been carried out with the idea 
of impressing upon the people of the com- 
munity the necessity of a periodic health ex- 
amination. Every well conducted business 
takes stock at least annualy to determine 
the state of its affairs. Is not the business 
of life about the most important business 
with which any man is concerned? Then 
why not make a yearly audit of the body 
mechanism to determine the degree of wear 
and tear upon its various parts and organs? 
It is in this way we may expect to aid in 
prolonging life, a most desirable hope of 
ecah one of us. This plan is recommended 
to the various parish organizations. 

It is not appalling to think approximate- 
ly one person in every ten is subject to 
cancer? And of this number 20 per cent 
have cancer of the stomach. On a recent 
visit to one of the large Clinics of this 
country a prominent member of the Staff 


196 


Irwin — Address of Welcome on Behalf of the Local Profession 


reported that of the patients coming there 
who suffered with cancer of the stomach 
50 per cent were grossly evidently inoper- 
able and were sent home. Of the remain- 
ing 50 per cent half again showed upon 
exploration the disease had already prog- 
ressed to a degree where there was no 
possible aid from surgery. Therefore only 
25 per cent of all cases of cancer of the 
stomach seen at that Clinic come in in an 
operable state. Why is this? They either 
do not consult their physician early enough, 
or the physician does not recognize the 
condition, or the patient has not fo’lowed 
the advice of his physician. 

Unfortunately, there are more corner 
druggists prescribing medication for 
peoples’ ailments than are doctors. This is 
a pernicious habit and extremely detri- 
mental to the well-being of the community. 
While the people should be educated not to 
become corner drug store patients but 
should have a complete study of their 
stomach complaints by a competent physi- 
cian, at the same time the physician himself 
shou d net become a drug house doctor 
having the slogan, “After eating reach for 
baking soda.” The best remedy for these 
astounding figures on cancer, is through 
early medical advice and thorough examin- 
ation, always erring on the side of safety 
to the patient. 

Medicine has always had an economic 
position in the business of the community 
and it shall continue to occupy a close 
relation to business. Certainly New Orleans 
itse'f owes its existence and progress to 
the discoveries and accomplishments of 
Medicine. It has not been beyond the 
memory of many of you that this section 
was cursed with the most feared and 
dreaded diseases. Chief among which were 
yellow fever, bubonic plague, smallpox, 
typhoid fever and malaria. These were bad 
enough in themselves, but the psychological 
effect exerted a demoralizing influence upon 
our population and prevented tourists from 
visiting our City, diverted settlers and 
business into other regions, thus retarding 


the economic and industrial growth of the 
Community. The former, yellow fever and 
bubonic plague, have been eradicated, while 
the latter three, smallpox, typhoid and 
malaria, are curiosities by comparison. 

You can recall the unsanitary condition 
of the open gutters, filled with garbage and 
slime, alive with larvae, the cisterns a 
breeding place for the mosquito, the surface 
out-house toi ets, all constituting means for 
the transmission of disease. 

With the elimination of these through 
improved sanitary measures our community 
was transformed from an undesirable and 
dreaded place in which to live into a City 
of health and beauty and prosperity. No 
longer does one fear to visit here, no longer 
do the inhabitants themselves flee to other 
climes to escape ill health. 

So today when one gazes in wonderment 
upon the mighty Mississippi as it rolls its 
way to the Gulf, viewing great merchant- 
men engaged in commerce with the four 
quarters of the g’obe, as one looks at the 
towering office buildings, virtual beehives 
of humanity, as one sees a busy populace 
bustling along magnificent streets and 
boulevards, as one visits the wonderful 
public schools, he realizes the great expen- 
diture of wealth, the triumph of architec- 
ture and engineering necessary for such, 
but he fails to reflect and become conscious 
of what really made it all possible — the 
elmination of disease and improvement of 
sanitary conditions through accomplish- 
ments of medical science. 

Even now a new order of things is being 
created in the professional history of our 
city. Just as New Orleans is facing a great 
advance in her business, so also is the medi- 
cal profession facing a great advance. She 
has always occupied a strategic position of 
medical education and her fame is known 
throughout the world. We are blessed with 
a capable and competent profession. We 
are fortunate to have this grand temp’e of 
learning which houses our great Tulane 
Medical School possessing an enviable and 


Barrow — Response to Address of Welcome 


197 


glorious reputation for medical teaching. 
We have the magnificent clinics of our great 
Charity Hospital with its vast volume of 
material a great portion of which has never 
been cultivated. There is the Medical 
School of our splendid State University, 
and now comes the Mid-winter Clinics. 
So, with all these organizations co-operat- 
ing harmoniously, in a great spirit of 
sympathetic understanding for the common 
purpose for which all medical schools and 
associations are created — the efficient train- 
ing of physicians to enable them to 
efficiently care for the sick — it is believed 
New Orleans shall become with these ad- 
vantages the mecca for medical training in 
the United States. 

Then, gentlemen, you must yourselves 
realize you are a part of the profession of 
New Orleans and you must join with us in 
the proper enjoyment of these privileges. 
The members of the profession of our city 
express greetings to the visiting members 
of the Louisiana State Medical Society, ex- 
tends the happy hand of fellowship to you, 
and hopes your stay will be as pleasant for 
you as we assure you it is for us. Welcome. 

RESPONSE TO ADDRESS OF 
WELCOME* 

S. C. BARROW, M. D.,f 
Shreveport, La. 

Mr. President of the Orleans Parish 
Medical Society, Mr. Mayor of the great 
city of New Orleans and Your Excellency, 
the great Governor of the great State of 
Louisiana : On behalf of the Louisiana 

State Medical Society, I wish to thank you 
for your kind words of reception and your 
hospitable welcome, and assure you that 
individually and collectively they are ap- 
preciated. 

In coming to the city of New Orleans, 
however, in annual convention we come 
not as strangers among strangers, but we 

*Read before the Louisiana State Medical 
Society, New Orleans, April 14, 1931. 

fPresident-elect, Louisiana State Medical Society. 


come as friends to mingle with friends in 
furthering a cause than which no nobler 
exists, the advancement of the aims and 
ideals of organized medicine. 

In the days gone by, there seemed to 
exist an intangible barrier between the 
people and the doctors of New Orleans and 
those of the state at large, a barrier which 
seemed to rear its head in dissension in 
all matters of debate, political, civic or 
scientific. However, through the processes 
of evolution the differences have been 
smoothed out, misunderstandings to a 
great extent have been forgotten, and 
we are today one people, one scientific, 
civic and political democracy. 

Louisiana has always recruited leaders, 
and able leaders, from among her ranks. 
In the dark days of the past, according to 
history, there arose leadership to meet 
every crisis in every department of life. 
For the future and present we have no 
fear. 

Dotted throughout our state today in 
every community we find hospitals thor- 
oughly equipped and properly manned to 
care for the needs of the sick, and thanks 
to the civic genius of our distinguished 
fellow citizen, leader and Governor of the 
state, there are now, and being constructed 
great permanent highways making accessi- 
ble these and other facilities to all. 

Organized medicine claims a big part in 
the development of Louisiana, we realize 
thoroughly there is yet much to be done, 
many plans to be made, and it is for this 
purpose that we are now assembled in 
your city. 

My function, Mr. Chairman, is to re- 
spond to the address of welcome. As Pres- 
ident-Elect of the State Medical Society I 
crave one moment to say that it will be 
the aim of the state administration, the 
state medical administration, for the next 
year to maintain harmony and scientific 
progress to its utmost ability. I am sorry 
after there seems to be a thorough amal- 


198 


Case Reports and Clinical Suggestions 


gamation of the interests of the coun- 
try with the city in medical matters we 
should find a little spirit of antagon- 
ism among the profession of this great 
city, a spirit which should not, must not, 
and has no reason for existing, a feeling 
which I am confident will be smothered 
out and harmony will reign. Should there 


be any necessity for effort to be exerted by 
the medical administration of the state, it 
will be forthcoming if desired, in the in- 
terest of all. 

I thank you, Mr. President, on behalf 
of the State Medical Society for your cor- 
dial words of reception, for we know, as 
we have learned in the past, that they are 
spoken with true sincerity. 


CASE REPORTS AND CLINICAL SUGGESTIONS 


A CASE OF NEUROLOGIC INTEREST.* 

CECIL LORIO, M. D., 

Baton Rouge, La. 

R. M. D., of Baton Rouge, Louisiana, white 
male, aged 11 years, weight 75 lbs, healthy other 
than the present condition. Past history: Father 

and mother living and well No history of epilepsy, 
severe headaches, insanity, asthma, rheumatism, 
cancer, or tuberculosis. Five pregnancies, one of 
which was a miscarriage, 2 months, between the 
second and third child. Four living boys, one mar- 
ried with two health children. Birth history: 
Child was born January 1, 1920, high forceps de- 
livery, weight 8V 2 lbs., labor very hard and much 
prolonged. Following birth, the baby was easily 
resuscitated, no cyanosis, cried and nursed vigor- 
ously. His general condition appeared good with 
the exception of an abrasion over the right occi- 
pital region due to the pressure of the forceps. 
The attending nurse was of the opinion that there 
was some injury because of a great amount of 
crying, though the records did not show any tem- 
perature or signs of irregular respirations nor was 
there any history of protrusions of the tongue or 
holding the head backwards. Past history: The 

usual diseases of childhood, including measles, 
chicken-pox, whooping cough between 3 to 5 years 
of age. First teeth at 7 months, sat erect at 
6 months, walked at 10 months, talked at about 
2 years with no apparent disturbance of speech. 
Has not had rheumatism, growing pains, chest 
diseases, or brain diseases. Removal of tonsils and 
adenoids was done at the age of 2. Complaint: 

* Presented at the Louisiana State Pediatric 
Society, April 13, 1931. 


Epileptic spells, lack of proper function of the 
right arm and leg. Present illness: The present 

condition made its first appearance when at the 
age of 4V 2 years the father was playing with the 
child, holding him by both arms swinging and 
tossing him over his back he noticed that the child 
complained of a pain in his right arm. The father 
thinking that he had dislocated the arm made re- 
peated attempts with tension to reduce a supposed 
dislocation but the next day the arm was appar- 
ently normal and not painful. Three months later 
the mother noticed a tremor of the right hand, 
lasting about 1% minutes, and her description of 
it was that of a tonic contraction of the muscles 
of the hand; this condition occurred three or four 
times during that year. About the age of 5 years 
the family noticed these tonic convulsions were in- 
volving the entire right arm and at once consulted 
an orthepedic surgeon in Oklahoma City where 
they were residing. The child was complaining 
that his arm would go dead at times which was 
brought on mostly following intense exercise. 
During the visit to the orthopedic surgeon and 
while in the office being examined by the doctor 
he developed one of these attacks in the right arm 
which lasted about 1 minute and which the child 
described as though electricity was running 
through it. Immediately he referred the child to 
a neurologist who diagnosed it as Jacksonian 
epilepsy and treated it with small doses of luminol, 
which was ineffective. From then on the child’s 
condition grew progressively worse. The convul- 
sions of the right arm and shoulder were not 
accompanied with any loss of consciousness or 
dulling of the sensorium, nor was there any 
parasthesia or disturbances of sensory function. 
At this time the attacks were at intervals of one 
to three weeks. Somewhile later there seemed to 
be a spreading of the areas, gradually involving 


Case Reports and Clinical Suggestions 


199 


the entire right half of the body. About the age 
of 5 some of the attacks were accompanied with 
a lethorgic state. During November, 1925, at the 
age of 5 years, the child was taken to a brain 
surgeon in St. Louis, who made a tentative 
diagnosis of left cortical tumor, suggested opera- 
tion, but was postponed and gave luminal treatment. 
From this time until the fall of 1926, one year, 
the child went to school, was entirely free from 
attacks and led his classes in a most precocious 
manner, but the attacks then returned and were 
involving the right face, arm and legs, and occur- 
ring three to four times a month, and each spell 
was accompanied with euphobia, continuous chat- 
tering, but no loss of consciousness. January, 
1927, he was taken to the Mayo Clinic, where 
complete examinations were made with a diagnosis 
of Jacksonian epilepsy; advised against operation 
and put on a ketogenetic diet which was main- 
tained under the strictest supervision. Two months 
following, the arm and hand began showing de- 
formity, the forearm being flexed on the arm and 
the hand flexed on the forearm, so that the position 
was flexion, making it practically useless in the 
performance of his regular duties. The tonic con- 
vulsions at this time were as many as 10 to 14 a 
night, none during the day, occasionally being 
accompanied with unconsciousness, but at no time 
was the leg or arm paralized. In February, 1928, 
at which time the attacks were very frequent and 
severe, he was returned to the brain surgeon in 
St. Louis. Roentgenograms showed convolutional 
markings but no tumor shadow. A craniotomy per- 
formed, finding a typical looking epiplytic cortex 
with engorgement, ironing of part of the gyri, in- 
creased ventricular pressure, but no tumor. The 
arm motor center was located in the prerolandic 
area by means of the galvanic current and it was 
found that it lay directly under a very large 
Krause vein which he did not care to excise as it 
might have caused marked symptoms. He, there- 
fore, injected alcohol into the cortex with the idea 
of destroying the arm center (a procedure which 
since then has been given up). With a thorough 
needling of the cortex he could not locate a tumor. 
Following the operation the child was apparently 
very much improved in so much as the number and 
intensity of the attacks were less and a greater 
part of the function of the right half of the body 
returned: school duties were maintained at a high 


standard with apparently no mental defect or 
dulling. This improvement was fairly constant 
until about 18 months later in September, 1929, 
when the condition again became progressively 
worse, being accompanied each time with uncon- 
sciousness. His condition becoming grave, so 
much so that his left hand was being involved and 
he had difficulty in walking due to awkwardness 
and stumbling. This was the time when I first 
examined the child, and recognizing his severe 
neurological condition referred him to a neurologist 
in New Orleans, who examined him thoroughly and 
returned him with the following report: 

Cranial Nerves — 

I. Normal. 

II. Choked disc, R. & L. about 3D, vision re- 
duced but not measured, no field defect for form 
on rough examination. 

III, IV, & V. No ptosis, extra ocular movements 
normal, no nystagmus, pupils equal and regular, 
react to light and in convergence. 

VI. Normal, motor and sensory (corneal reflex 
present) . 

VII. Normal. 

VIII. Hears watch tick normally, vestibular 
function not tested. 

IX. X, & XI. Normal. 

There is a definite paresis of the right side but 
no muscle is actually paralyzed; he walks with a 
limp and does not use the right hand although the 
strength is fair. The left side is also weak but 
markedly less so than the right — the movements of 
the left lower extremity are fair but those of the 
upper are very much impaired. The impairment 
which he shows is apparently due to a lack of 
synergic control, not a cerebellar incoordination but 
to the occurrence of athetoid movements ; he cannot 
write or button his clothes with the right hand at 
all and very poorly with the left. 

The sensorium was normal throughout, he stands 
in Romberg’s position, there is no astereognosis. 

The tests for coordination were rather poorly 
performed, but one was impressed with the inter- 
ference by athetosis rather than any true inco- 
ordination. There was a slight tremor of the ex- 
tended hands. 


200 


Case Reports and Clinical Suggestions 


Superficial reflexes were present and equal, all 
tendon reflexes were very sluggist with little 
difference between the two slides, even so he would 
occasionally show a few strokes of clonus on the 
right but never sustained. Pathological reflexes 
were not elicited. He showed no Kernig or Lasegue 
sign, the neck was not stiff. 

One cannot escape the impression that this 
child is afflicted with a tumor of the brain, based 
both on his history and physical finding. I am 
aware that he has been explored by a very out- 
standing neurological surgeon who could not 
demonstrate the presence of a tumor, but my 
impression is that at the time of the exploration 
the tumor was probably present and was situated 
so deeply that it was impossible to reach it. It is 
probably near the base and near the midline, start- 
ing perhaps on the left side and now involving both 
sides. The signs he shows point to involvement of 
the basal nuclei. He has had the benefit of an 
exploration with a decompression and I feel skepti- 
cal as to the benefit to be derived from further 
surgery, but at the same time I feel now as I did 
then, that you should communicate with the 
St. Louis doctor and obtain his opinion. In as 
much as his seizures are becoming more frequent 
and are markedly increased when the luminal is 
omitted I believe that it is advisable to continue 
with this medication. 

Very truly yours, 

A. B. 

Two months later the child’s condition grew so 
much worse that I again sent him to the neurolo- 
gist in New Orleans who then reaffirmed the diag- 
nosis first made of a deep seated brain tumor, 
hopeless. Returning from New Orleans I made a 
complete examination and found that the child was 
unable to walk because of the left sided involve- 
ment. The onset of this left side development 
began with an awkwardness, frequent stumbling, 
dropping objects from his hand, spilling foods and 
generally nervous. With the hands extended a fine 
tremor was noticed with irregular twitchings of 
the fingers also a tremor of the tongue was 
noticed. Speech became much affected so that it 
was impossible for him to enunciate, therefore 
he could not be understood. The mental condition 
remained good and the mother was required to read 
to him almost continuously. Facial grimaces 


noticed, muscular movements were rapid, irregular, 
involuntary and of wide excursion. A twitching 
of the fingers and incoordinate convulsions of 
the hand and left were present. Both patellar 
reflexes were exaggerated with a questionable 
Babinski. The optic discs were normal with pos- 
sible a slight engorgement of the retinal vessels. 
The child lay in a very restless, helpless, painless 
and at times listless position, unable to perform 
his daily duties. On several occasions there was 
urinary retention and only twice did he have any 
headaches, though there was at times a tendency 
towards visual disturbances. It was during the 
first week of this late development that the neu- 
rologist in New Orleans thought the child hope- 
lessly affected with a deep seated tumor incroach- 
ing on the brain areas that involved the left side 
of the body. But, strange to say, all of the 
symptoms subsided shortly thereafter and the 
child progressively improved to such an extent 
that the parents were of the opinion that he was 
in a better condition than ever before since the 
origin of the trouble. About eight months later, 
in August, 1930, there was a recurrence of the 
above described condition — that is, awkwardness, 
stumbling, dropping of objects, spilling foods, 
tremor of hands and tongue, blurring of speech, 
rapid, irregular and involuntary muscular move- 
ments of wide excursion. This last attack lasted 
about three weeks to one month. Following the 
subsidence of these symptoms his co-ordination has 
not been very good and at the present time his 
physical examination reveals spasticity of the right 
arm and leg. Athetoid movements at times are 
rather pronounced and he is unable to control the 
right hand as usefully as the left. Speech de- 
cidedly blurred but has been since I have first seen 
him. Sensation to heat and pin point is normmal; 
is unable to stand erect on the right leg with the 
left elevated. A noticeable spasticity of the right 
side is present and at the present time he is having 
tonic convulsions of the right arm and leg and 
sometimes the entire body, usually about once 
during the night lasting two or three minutes. 
Grasp is unequal; he is very tired most of the 
time and seems to hold the head inclined to the 
right. When his tonsillectomy was done the uvula 
was removed. Wassermann, negative, urine nega- 
tive, blood count normal, stool negative. Spinal 
punctures were not done because of the seriousness 


Case Reports and Clinical Suggestions 


201 


of the child during each attack and because of the 
prevailing diagnosis of tumor of the brain pre- 
viously made; although I do think it has on several 
occasions been indicated and that at any subsequent 
attacks I intend doing it. 

DISCUSSION. 

From the history, symptoms, and physi- 
cal examination one is at once impressed 
with the regularity and progressiveness of 
events occurring in this child. From early 
childhood until the present day he has had 
a physical disturbance of the right side of 
his body indicating some type of upper 
neuron lesion. The attacks have repeatedly 
indicated pathology involving an area 
located between the basal neuclei and the 
cortex of the left side. Several of the South’s 
most eminent neurologists have agreed on 
the diagnosis of tumor but have been un- 
able to show proof. One of them attempted 
to locate it after doing a decompression 
but was unable to find it. His symptoms 
have been similar with every attack, having 
a tonic convulsion of the right arm and leg, 
and at times encroaching upon the opposite 
side as though following the anatomical 
location of the centers of the brain and 
usually not accompanied with sensory or 
physic disturbances, consciousness usually 
being present. History of trauma, infan- 
tile cerebral palsy, heredity, acute inflam- 
matory disease of the brain, or any other 
referable etiology is entire 7 y lacking. It is 
apparent that this child is of the Jack- 
sonian type of epilepsy with some brain 
pathology, probably a circumscribed in- 
flammation, the most common of which are 
due to trauma, tumor, abscess, gumma, 
tubercle, local meningitis, post-encephalitis 
and localized edema of the brain may be 
ruled out by symptoms. Trauma, even in 
the absence of history, must be considered. 
Vascular lesions and scar may be present 


without our knowledge of it. So that it 
would be ’ogical to conclude that the source 
of the epileptic seizures is some circum- 
scribed inflammatory area of the brain but 
of questionable location and type. From 
the history it will be noted that the child 
has had three severe individual and distinct 
attacks of a condition which does not cor- 
respond with the usual type of Jacksonian 
epilepsy. This refers to those periods of 
three to eight weeks duration when the 
child was sluggish, awkward, stumbling, 
generally nervous, dropping objects, tremor 
of the hands, irregular twitching of the 
firgers, tremor of the tongue, facial grim- 
aces, rapid muscular movements of the 
irregular, involuntary and wide excursion 
type. The above syndrome reminds one 
conclusively of some type of generalized in- 
flammation or irritability of the brain, 
i. e. y chorea. Whether or not these symp- 
toms were the true rheumatic chorea or -due 
to a general nerve irritation radiating from 
some central focus (the Jacksonian focal 
area) is open to conjecture. His mental 
characteristics appear normal and he does 
not have the epileptic make up — that is, of 
volative exp’osive temper, egotism, sensa- 
tiveness, with impaired memory and mental 
retardation. Though he does not give evi- 
dence of being abnormally brilliant, his 
intelligence is at par. Julius Caesar, Peter 
the Great, Napoleon and other brilliant men 
had epilepsy, so that it does not necessarily 
indicate that this child’s mental condition 
will be below normal. In conclusion, it may 
be said that this child is affected with an 
epilepsy of the Jacksonian type, and judg- 
ing from his past treatments, both medical 
and surgical, it is to be expected that there 
will be a continuance of symptoms unless 
it will be posssible to locate and remove the 
offending factors. 


202 


Editorials 


NEW ORLEANS 


Medical and Surgical Journal 

Established 1844 

Published by the Louisiana State Medical Society 
under the jurisdiction of the following named 
Journal Committee: 

S. C. Barrow, M. D., Ex-Officio 
For one year: W. H. Seemann, M. D., 

Randolph Lyons, M. D., Secretary 
For two years: John A. Lanford, M. D. 

For three years: S. M. Blackshear, M. D., 

H. W. Kostmayer, M. D., Chairman. 


EDITORIAL STAFF 


John H. Musser, M. D.. ... 
Leon S. Lippincott, M. D. 
Willard R. Wirth, M. D... 
H. Theodore Simon, M. D. 

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D. W. Jones, M. D 

Jacob S. Ullman, M. D 


. . .Editor-in-C hief 

: Editor 

Editor 

. Associate Editor 
..Associate Editor 
..Associate Editor 
.Associate Editor 


COLLABORATORS— COUNCILORS 


For Louisiana 
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Daniel N. Silverman, M. D. 
C. C. DeGravelles, M. D. 

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C. P. Gray, M. D. 

J. H. Slaughter, M. D. 

D. C. lies, M. D. 

J. H. Landrum, M. D. 


For Mississippi 
J. W. Lucas, M. D. 

L. L. Minor, M. D. 

M. W. Robertson, M. D. 
Thomas J. Brown, M. D. 
Willie H. Watson, M. D. 
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J. W. D. Dicks, M. D. 

D. J. Williams, M. D. 


Paul T. Talbot, M. D General Manager 

1430 Tulane Avenue 

SUBSCRIPTION TERMS: $3.00 per year in 
advance, postage paid, for the United States; $3.50 
per year for all foreign countries belonging to the 
Postal Union. 

News material for publication should be received 
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ing publication. Orders for reprints must be sent 
in duplicate when returning galley proof. 

The Journal does not hold itself responsible 
for statements made by any contributor. 

Manuscripts should be addressed to the Editor, 
1430 Tulane Avenue, New Orleans, La. 


THE POTENTIAL MALIGNANCY OF 
WARTS AND MOLES. 

Under the above caption Maes* has 
written most sensibly in # the editorial 
columns of Surgery, Gynecology and Ob- 
stetrics. His theme is so trite and so com- 
monplace that it hardly seems necessary to 
accentuate what this sterling surgeon has 
written, but it is just such apparently tri- 
vial things that we are wont to overlook 


"'Maes, Urban: The Potential Malignancy of 

Warts and Moles, Surg., Gynec., and Obst., 8:111, 
1931. 


and certainly frequently neglect; they may 
not be of unusual interest but are of ex- 
treme importance. As Maes writes, these 
insignificant and harmless neoplasms in 
many instances are potentially malignant, 
and may untimately result in the death of 
the patient as a result of widespread me- 
tastases. There is no way of being able 
to determine the susceptibility of the in- 
dividual to cancer or to the liklihood of the 
apparently bengin growth becoming malig- 
nant.f Therefore, it is the duty of physi- ! 
cians to explain to the patients the possibil- i 
ities that may occur, particularly if moles i 
or warts are subject to frequent trauma , 
and to suggest their immediate removal, i 
nay, to insist that they be removed prompt- j 
ly, either by the knife or by electro-surgery. I 


THE PRESENT DEPRESSION 

A spirit of pessimism seems to prevail ! 
widespread throughout the United States. I 
This great country, which only a few years I 
ago was riding high on the crest of afflu- 
ence and industry, has gone to the other 
extreme and has dropped into the slough 
of economic despond. Undoubtedly a great 
deal of this depression represents a most 
interesting psychic phenomenon. Of the 
great bulk of Americans working at the 
present time, estimated at 85 per cent of 
the wage earning population, a goodly 
percentage of those that are employed have 
not suffered loss of income, and are as 
comfortable as they were in the days of 
great prosperity; but not so contented. 
There is a certain fear prevalent that 
things may go from bad to worse, a 
thought which is most depressing to these 
individuals who are employed. Just at the 
present time the financial situation seems 
to be improving, and it is quite possible 
that in a relatively few months there will 
be betterment in all lines of industry. 

To the doctor the depression is particul- 
arly hurtful. The physicians’ bills are al- 


fNote case of Dr. Johnston, in Section of Hos- 
pital Staff Transactions, p. 208. 


Editorials 


203 


ways those that are paid last, and many 
people even though well able to pay the 
doctor are using the present situation as 
an excuse for postponing the meeting of 
their obligations to the physician. They 
are using the depression as a reason for 
non-payment of their bills and the doctor 
suffers. The patients who are on a fixed 
salary, which has not been modified by the 
present day conditions, are in many in- 
stances doing this, forgetting that the phy- 
sician has his office rent to pay, his auto- 
mobile to keep up, and his technical equip- 
ment to maintain. The only hope that can 
be held out for the near future is that 
there is some clearing of the economic sky. 
and the woeful fear and often spurious 
dread of the future will banish from the 
minds of those who have no reason to have 
it. When this happens it is quite possible 
that the physician will become relatively 
affluent for a short period at least, be- 
cause, after all, unpaid bills are usually 
paid sometime or another, and it is per- 
haps possible that bills due in reasonably 
large numbers will come flowing in more 
or less simultaneously. 


ARISTIDES AGRAMONTE. 

Several months ago Dr. Agramonte came 
to New Orleans to occupy the Chair of 
Tropical Medicine in the New Louisiana 
State University Medical School. The ar- 
rival of Dr. Agramonte in New Orleans 
was hailed by the local and state medical 
profession as a great addition to medicine 
in this vicinity. Elaborate plans had been 
made by Agramonte and by the authorities 
of the new school for the development of 
an outstanding Department of Tropical 
Medicine. Distressing and sad indeed is it 
to hear that this outstanding physician ap- 
parently in the full vigor of health suc- 
cumbed suddenly to a heart attack on 
the seventeenth day of August. 

Dr. Agramonte needs no introduction 
to the medical profession of the United 
States, but to the medical world of Louisi- 


ana and New Orleans his fame and repu- 
tation is known intimately on account of 
the bearing that the results obtained by 
the United States Army Yellow Fever 
Commission had on local health conditions. 
Although yellow fever at one time had 
been a scourge of the entire eastern sea- 
board from Boston southwards, at the time 
the Commission functioned it was only in 
the cities of the southern United States 
that bordered the Gulf that epidemics of 
yellow fever were likely to occur. This 
Commission rendered to New Orleans, as 
the largest City of the South and on the 
Gulf, a service which can not be estimated 
in monetary values nor in the number of 
lives saved. Agramonte was one of the 
active protagonists of the mosquito theory 
advanced most forcibly by Findlay, and 
it was natural that he should be appointed 
to the Yellow Fever Commission, organized 
by Walter Reed. His name with that of 
Carroll and of Lazear will rank just under 
that of this great American Army Sur- 
geon. 

The life of Agramonte is one of varied 
interest. Born in Cuba, as a child he was 
taken to Mexico and when twelve years of 
age came to New York City. He went 
through the usual preliminary school and 
medical education to become a doctor in 
1892. Apparently he was destined to prac- 
tice the remainder of his life in New 
York City, but at the onset of the Spanish 
American War he promptly threw up his 
civil appointments and entered the United 
States Army. In 1902 he resigned from 
the Army and went to Havana as Profes- 
sor of Bacteriology in the medical school 
of that City. In the years that intervened 
before coming to New Orleans, his life was 
a full and busy one. In addition to his 
active teaching and investigative work, he 
was the outstanding practitioner of med- 
icine in Havana, and was almost, were 
such a thing possible, the official doctor to 
the American Colony in the capital of 
Cuba. During these years many honors 
were showered upon Agramonte, and he 


204 


Hospital Staff Transactions 


was most active in various types of public 
health work in the Republic of Cuba. 

In 1928 Dr. Agramonte was a guest 
speaker at the meeting of the American 
College of Physicians in New Orleans. He 
contended strongly that the concept of 
Noguchi, that yellow fever was due to a 
specific leptospiral organism, was incor- 
rect. Time has substantiated Agramonte’s 
contentions. 


To those who knew this great Cuban- 
American physician his loss will be a very 
real one. A charming gentleman and de- 
lightful host, as those who have visited 
Havana well know, Agramonte was a 
friend worth knowing. To those who were 
not personally acquainted with him, the 
potentialities of his presence in New Or- 
leans held out so much that his going will 
be equally a real blow. 


HOSPITAL STAFF TRANSACTIONS 


KING’S DAUGHTERS’ HOSPITAL, 
GREENVILLE. 

The staff of the King’s Daughters’ Hospital, 
Greenville, met July 8, and held a short snappy 
program after our dinner at 7 P. M. in the hos- 
pital dining room. The staff meets every second 
Wednesday in the month. 

Dr. T. B. Lewis gave an interesting case report, 
after bringing up for discussion the subject of 
mortality in appendicitis. He reported some of 
the statistics of a prominent insurance company 
and others, including Dr. Evans of Chicago, 
showing the surprisingly increased death rate 
from appendicitis in the past twenty years. The 
truth of this condition was challenged by our 
staff and especially by Dr. H. A. Gamble, who 
proved his point by his records of more than two 
thousand cases since 1918, with seven deaths or 
less than one-third of one per cent. The records 
of the other men here will probably show about 
the same percentage of mortality. So for this 
part of the State we cannot agree with the alarm- 
ing reports as given. 

Dr. Lewis also reported a case of appendicitis 
and partial obstruction of the bowel produced by 
a large round worm. The worm had coiled up in 
the ileum about twenty inches from the ileo-cecal 
valve and the bowel down to the cecum was com- 
pletely collapsed and considerably inflamed. An 
acutely inflamed appendix was removed. The de- 
sire to remove the worm through an opening in 
the gut was overcome. The coil was broken up 
and left to find its way out under the influence of 
a vermifuge given a few days later. The worm 
did no further harm and the patient had a quick 
and uneventful recovery. 

J. C. Pegues, Secretary. 

CHARITY HOSPITAL, NATCHEZ. 

Report of a Case of Intestinal Obstruction Due 
to Ascaris Lumbricoides — Dr. T. H. Rayburn, 


House Surgeon, in collaboration with Dr. E. E. ! 
Benoist, Natchez, and Dr. C. A. Everett, Bude. 

History: C. R., colored, female, aged 2 years, 

was admitted to the Natchez Charity Hospital, 
June 8, 1931, case No. 1033. 

Her present illness started three days before i 
admission with diarrhea and vomiting of a per- | 
sistent character, pain in lower abdomen, and j 
some fever. She was given castor oil one day j 
prior to admission which acted once. The last I 
few hours before admission, vomiting ceased, | 
straining at stools was noticeable and stools con- 
tained only dark brown fluid and mucus. It was i 
not until operation had been performed that her j 
mentally deficient father recalled that she had j 
passed a few round worms about three weeks j 
previously. 

Physical Examination: A well developed and 

well nourished colored female about three years ! 
of age, lying on examining table, apparently very | 
ill and irritable with periodic (every 2 to 3 
minutes) outcrys suggesting pain of a spasmodic j 
character. Temperature 99° F. by axilla, pulse I 
100. No deformities or other acquired or con- 
genital stigmata present. Head, heart, and lungs 
clear. 

Abdomen moderately distended and tympanitic. ( 
Mus.les were somewhat tense but could be con- ' 
trolled by suggestion and gentle stroking, after , 
which palpation could be done with fair ease, j 
There was a firm, freely movable mass, the cir- ) 
cumference of which was that of a large orange, 1 
and the length about eight inches. It extended 
from about four inches above to about four inches i 
behw and to the right of the umbilicus. Manipu- 
lation of mass caused very little discomfort. 
Rectal examination revealed a large, firm, freely 
movable and onlv slightly tender mass which 
started in right ilia ^ fossa and extended upward. ! 

Laboratory: Admission blood count: W. b. c., : 

17,850; polys., 77 per cent; lymphocytes, 19 per , 


Hospital Staff Transactions 


205 


cent; transitionals, 2 per cent; eosinophiles, 1 per 
cent; basophiles, 1 per cent. 

Preoperative Diagnosis: Intestinal obstruction. 

As a causative factor, intussusception and 
Meckel’s diverticulitis were given as the most 
likely possibilities. Impaction by round worms 
was mentioned, but given little credence. 

Operation: A long mid-right rectus incision 

was made. As soon as the peritoneum was opened, 
the mass fell into the wound and an entangled 
mass of round worms was visible through the 
gut wall. Blood supply to gut was still fairly 
free and the gut wall was in recoverable condition 
except for a spot about the size of a dime. The 
mass started about eight inches above ileo-cecal 
valve and extended upward. The appendix was 
elongated, injected and inflamed. A small quan- 
tity of clear brownish fluid was recovered from 
the peritoneal cavity. The mass was delivered, an 
opening made in wall of gut and worms removed. 
After closing opening, another smaller mass was 
discovered about 10 inches above larger mass and 
gut wall was again opened and worms removed. 
Eighty-four large round worms from 6 to 14 inches 
in length were recovered. A large hard rubber 
catheter was inserted into ileum about 10 inches 
above valve, retained by two purse-string sutures, 



Mass of Round Worms Cousing Obstruction of the Intestine. 


and anchored to parietal peritoneum at lower 
angle of incision. Incision closed in layers with- 
out drain in peritoneal cavity. 

Postoperative Care and Course: Beginning on 

first postoperative day, when the temperature was 
101.6° F. by axilla, there was a, gradual decline, 
temperature never again going above 100° F., 


and by the end of the fifth day and for the re- 
mainder of the convalescence period there was 
no fever. Her general condition followed the 
temperature curve. There was considerable rest- 
lessness for first week. The abdomen was per- 
fectly soft from the beginning. During the first 
two weeks the ileostomy opening drained profusely 
soft fecal material and worm fragments well 
diluted with fluid. During third week opening 
drained only slightly and by the end of the third 
week opening had ceased to drain at all. 

After beginning of second week bowels started 
moving from below, she took plenty of nourish- 
ment, became playful, and rapid recovery was 
evident. During latter part of third week urine 
showed only occasional pus cells in a voided speci- 
men; Rbc., 5,580,000; Hb. 100 per cent (Tall- 
quist). 

Kahn test on blood was unsatisfactory. She 
was discharged into the hands of the family 
physician on the twenty-sixth day in excellent 
condition. 

VICKSBURG SANITARIUM AND CRAW- 
FORD STREET HOSPITAL. 

Staff Meeting — August 10, 1931. 

Abstract: Carcinoma of the Stomach — Dr. A. 

Street. 

Patient: White, female, age 59, married, two 

children; admitted to hospital July 15, 1931. 

Present Illness: Since having a bad spell of 

influenza four months ago, patient has been having 
afternoon temperature, 99 to 100° F., and failing 
in strength. She has lost 43 pounds in weight 
(from 183 to 140). Appetite very poor; no 
nausea; severe pain in left abdomen about the 
level of the umbilicus and occurring promptly 
after eating. This pain is often precipitated by 
a drink of water. There is no other pain than 
as above described. Bowels normal; sleeps well; 
no bladder disturbance; slight dyspnea on exer- 
tion ; no cough ; no tar stools. She thinks she 
notices a lump in the left abdomen at times. 

Physical Examination: Temp., 99.8° F.; blood 

pressure, systolic, 135. Well developed and nour- 
ished; skin, rather pale; teeth, false; tongue, 
slightly fissured and the middle third very red 
but not smooth. Abdominal examination shows 
no masses and no tenderness. Physical examin- 
ation otherwise not remarkable. 

Urine: Sp. gr., 1.023; slight trace of albumin; 

few fresh red blood cells. 

Blood: Hb., 62 per cent; erythrocytes, 4,200,- 

000; leukocytes, 9,200; small lymphocytes, 7 per 
cent; large lymph., 1 per cent; monocytes, 6 per 
cent; polym. neutrophiles, 83 per cent; polym. 


206 


Hospital Staff Transactions 


eosinophiles, 2 per cent; polym. basophiles, 1 per 
cent. Wassermann, Kline and Young, and Kahn 
tests negative. 

Fractional gastric analysis showed no free HC1; 
much mucus, lactic acid, a trace of chemical blood 
and microscopically a few fresh red blood cells. 
Blood urea nitrogen was 28 mg. per 100 cc.; 
blood sugar 83 mg. per 100 cc. 

Fluoroscopic and radiographic examinations 
showed a large mass in the central portion of 
the stomach, giving rise to a large, irregular 
filling defect. Roentgen-ray diagnosis: carcinoma 
of the stomach. 

Procedure: Exploration was advised in order 

to see whether or not the growth was operable 
and to remove it if operable. The stomach was 
lavaged each morning for seven days prior to 
date of operation, and the patient was fed bland 
soft food in small amounts and at frequent in- 
tervals. A suitable donor for transfusion was 
obtained and was present shortly before the time 
set for operation. The patient was taken to the 
operating room with the duodenal tube in the 
stomach. Before beginning the operation, the 
stomach was washed and one ounce of 1 per cent 
acriflavine solution injected into the stomach. 

Operation, July 23, 1931: Spinal anesthesia; a 

very high right hand paramedian incision. The 
distal half of the stomach is invaded by a large, 
hard, nodular growth. The anterior surface is free; 
the posterior surface is fixed. There are large 
glands in the gastro-colic and gastro-hepatic 
omenta. The liver is not apparently involved. 
The fixation of the posterior surface made oper- 
ability questionable, but palpation of the pancreas 
showed it free of induration and resection was 
decided upon. After ligating and dividing the 
blood vessels on the greater and lesser curvatures, 
the stomach was divided proximal to the growth. 
The condition on the posterior wall could then 
be observed much more accurately than before. 
As the stomach was rather low, part of it was 
in relation posteriorly to the mesocolon and maso- 
colon was invaded. One of the branches of the 
middle colic artery was within this portion. A 
temporary clamp was placed on this arterial 
branch, and the transverse colon carefully ob- 
served. It was finally decided that blood supply 
was not impaired and the artery was then divided 
and ligated and the involved portion of mesocolon 
resected. In doing this, a perforation was un- 
covered which allowed the escape of gas and some 
of the flavine colored content of the stomach. 
The granulating floor of the perforation was care- 
fully removed. The remainder of the mobiliza- 
tion was quite easy; the duodenum was divided 
and the stump inverted. The proximal jejunum 
was drawn through the opening which was made 


when part of the mesocolon was resected, and 
the entire end of the stomach was anastomosed to 
the side of the jejunum (Polya operation). The 
margins of the opening in the mesocolon were 
then stitched to the stomach just proximal to the 
line of anastomosis. The peritoneum was closed 
and a small drain placed in the abdominal wall. 
A transfusion of 600 c.c. of citrated blood was 
given during the operation. The duodenal tube 
was left in the stomach. 

Subsequent: The patient’s convalescence has 

been uneventful. She eats without discomfort 
and is to return home in a few days. There was 
some abdominal wall infection, but at no time 
was there abdominal distention or other evidence 
of peritoneal infection. 

Tissue examination by Dr. Lippincott showed 
adeno-carcinoma (Group IV), with much ulcera- 
tion. At site of perforation posterior growth ex- 
tends through wall and into adherent fatty tissue. 
Two lymph nodes examined showing hyperplasia 
and chronic inflammatory changes but no cancer. 


Abstract: Brain Tumor — Dr. J. A. K. Birch- 

ett, Jr. 

Patient: Colored, male, aged 28, former dining 

car waiter. 

Chief Complaint: Headache, nervous spells, 

vomiting. 

Present History: About six months ago began 

having headaches and dizzy spells; four months 
ago first noticed nervousness; unable to write or 
concentrate on any work, head and hands would 
tremble. Any excitement or prolonged conversation 
will precipitate coarse tremor of head. Complains 
of headache and after it develops will have severe 
vomiting which relieves condition for an hour or 
two. Then has tremor, headache and vomiting 
again. These phenomena have occurred as many 
as a dozen times a day. No loss of consciousness. 
At times not able to see well. There has been no 
marked loss of weight although there has been 
some steadily increasing weakness. No fever or 
chills. No evidence of any loss of muscle function; 
hearing normal. 

Physical Examination: Temp., 98° F.; pulse, 

60, full; blood pressure, 120/80; respiration, 18. 
Well developed and nourished. Eyes very prom- 
inent; no marked nystagmus; pupils react to 
light and accommodation. Examination of eye 
grounds under atropin showed marked bilateral 
choked disc. Knee jerks exaggerated. Spinal 
puncture showed fluid under markedly increased 
pressure and probably 60 c.c. of fluid escaped. 
Physical findings were otherwise essentially nega- 
tive. 

Blood Wassermann, Kline and Young and Kahn 
tests negative; spinal fluid Wassermann test and 


Hospital Staff Transactions 


207 


colloidal gold test, negative. Blood and urine 
showed nothing remarkable. 

Diagnosis: From history and physical findings, 

we think of brain tumor as the cause of the symp- 
toms, but other diseases giving the same or similar 
symptoms and to be ruled out are nephritis, lead 
poisoning, multiple sclerosis, epilepsy, paretic 
dementia, abscess and gumma. The diagnosis 
of brain tumor is based chiefly on the evidence 
of choked discs, constant headache of varying 
intensity and especially increased by excitement 
or exertion, vomiting which is always a valuable 
sign and when present usually follows headache 
and is projectile in character, slow pulse, vertigo, 
and epilepsy of Jacksonian type. 

In this case, the decidedly increased spinal fluid 
pressure, choked discs, the appearance of the sella 
tursica in the roentgen-ray plate, and the train 
of symptoms of headache, vomiting and eye dis- 
turbance suggest that the tumor is in the region 
of the hypophysis, although there is no evidence 
of the usual signs of perversion of the pituitary 
body secretions. This can be explained by the 
comparatively recent development of the tumor, 
which up to this time has apparently not interfered 
with pituitary secretions. The roentgen-ray in 
this case suggests a sarcomatous change with frag- 
mentation and destruction of the clinoid process. 


Abstract: Osteomyelitis, Acute. — Dr. G. C. 

Jarratt. 

Patient: White, female infant, aged 2 years, 

4 months; admitted to hospital June 11, 1931. 

Chief Complaint: Fever; convulsions; pain and 

swelling of left leg. 

Present Illness: Mother states that ten days 

ago child was taken ill with temperature of 105° F. 
Physician was called and pronounced the condition 
tonsilitis. Some fever the next day but was well 
up to four days ago, at which time she began to 
limp when walking. Fever then arose to high level 
and has been present since. At the same time 
swelling was noted in left lower extremity from 
knee to hip but most marked at knee joint. When 
attempt was made to move leg, child cried out 
with pain. Tonight about 10:30 o’clock, child had 
fever of 105.5° F., and generalized convulsions 
that lasted for two to three minutes. Another 
convulsion occurred at 11 P. M., lasting about two 
minutes. Has then been asleep since last con- 
vulsion and slept on trip to hospital (arrived about 
2 A. M.). 

Past History: No illness of any consequence 

except frequent attacks of tonsilitis. 

Physical Examination: Temperature 105.6° F. ; 

Blood pressure 130-90. Well developed and 
nourished; very acutely ill; drowsy but can be 
aroused. 


Head: Not remarkable; pupils equal and re- 

act to light and accommodation; ears normal; 
nose normal; 16 milk teeth; no membranes or 
Koplik’s spots; tonsils moderately enlarged but 
not inflamed. Neck: no glandular enlargement; 
no stiffness present. Chest: expansion good and 
equal; no rales, bronchophony or impaired reson- 
ance. Heart: no murmurs or enlargement. 

Abdomen: soft and flat; spleen and liver not 
palpable; no masses or tenderness. Genitalia: no 
discharge. Skin; no rash or petechiae; several 
areas of impetigo on chin. Central Nervous 
System: negative Babinski, Brudinski, and ankle 

clonus; knee jerks normal; Chvostek’s and Trous- 
seau’s signs negative. 

Extremities: upper and right lower normal. 

Left lower: there is marked swelling of left thigh 
from knee to junction of middle and upper thirds, 
increased heat, redness, and is very painful to 
touch or movement; no swelling of lower portion 
of knee joint; no areas of fluctuation; swelling 
seems deep. 

On June 11, blood showed leukocytes, 41,500; 
polym. neutrophiles 83 per cent; no malaria found. 
Urine: slight trace of albumin; granular and hya- 
line casts and few fresh red blood cells. Roent- 
gen-ray examination of left femur was negative. 

Diagnosis: Osteomyelitis, acute, of left femur; 

septicemia; acute hemorrhagic nephritis. 

Procedure: Child was taken to operating room 
and incision made along the middle and lower 
thirds of left femur on dorsal surface; dissection 
through muscles. Upon separating muscle bellies, 
there was a gush of about one-half pint of pus. 
The periostem had been dissected from the bone. 
Small holes were made through the shaft of the 
femur with electric drill, along middle and lower 
thirds. The wound was packed with vaseline gauze 
and splint applied to thigh and leg. Glucose solu- 
tion 10 per cent, 150 c.c. was given intravenously. 

Cultures of pus showed Staphylococcus aureus. 

June 12: Blood pressure 120/80; temp. 104.4° 

F. Spent a restless night and was very toxic. On 
night of June 12, noted redness and swelling of 
middle phalanx of left ring finger; very painful. 
Diagnosis, osteomyelitis, acute. 

June 13: Blood pressure 124/80; temp. 104° 
F. Blood: leukocytes 14,700. Urine: slight trace 
of albumin; no casts or blood. 

Incision made on dorsum of middle phalanx of 
left finger; pus found beneath the periosteum. 
Culture showed Staphylococcus aureus. 

June 15: Temperature 101.4° F. Child refusing 

nourishment and 200 c.c. of whole citrated blood 
given intravenously. Blood culture taken at this 
time showed Staphylococcus aureus and Strepto- 
coccus viridans. 


208 


Hospital Staff Transactions 


Subsequently child’s temperature remained 
around 100 to 101° F., she began eating and 
there was profuse drainage from femur and finger. 
Discharged from hospital on June 22, with nega- 
tive urine, and eating well. 

Since then child has remained free of fever and 
gained in weight. Femur still has some discharge. 
Roentgen-ray reveals good involucrum forming 
with very little destruction of shaft of femur. 


Abstract: Melanoma. — Dr. Walter E. Johnston. 

Patient: Colored, female, aged 31, widow; first 
seen at home July 8, 1931. 

Chief Complain: Weakness, loss of weight, and 
sore on forearm. 

Present Illness: Since birth patient has had a 
small mole, about half the size of a pea, on her 
right forearm. In December, 1930, while sweep- 
ing, she brushed her arm against a sharp nail. The 
nail penetrated the skin near the base of the 
mole. In several weeks a small black growth ap- 
peared at the site or the wound. This was treated 
with castor oil until February, 1931, at which 
time she consulted a physician who “burnt the 
growth off.” For about a month following this 
the wound healed very slowly. She states that it 
was almost well when she accidentally struck it 
again. Around the first of June she noticed a 
large knot in the right axilla. This has gradually 
enlarged until it interferes with movement of 
the arm. During the present illness she has had 
anorexia and has lost weight rapidly. She has 
become very weak and nervous. In the last 
few weeks she has rapidly grown worse. At the 
present time she is unable to feed herself and has 
probably lost 20 to 30 pounds of weight. 

Family and Past History: Essentially negative. 

Physical Examination: Weight 123 lbs.; temper- 
ature 99° F.; pulse 130; resp. 30; blood pressure 
110/80. Fairly well developed but poorly nour- 
ished; skin dry and shows signs of recent loss of 
weight. Slight general glandular enlargement. The 
most striking finding in the entire physical exami- 
nation is the enlarged lymph glands in the right 
avillary and supraclavicular regions. The nodes 
in the axillary region form a mass about the size 
of a lemon while those in the supraclavicular re- 
gion are as large as an orange, very firmly fixed 
and almost bonelike in consistency. 

Head, eyes, nose, mouth, and ears negative; 
marked enlargement of both lobes of thyroid; 
lungs, heart, abdomen, and pelvis negative; on 
dorsum of right forearm a smooth, skiny, firm 
black mass is seen, about 3 cm. in diameter. 

Urine negative; Wassermann test positive; bi- 
opsy and tissue examination shows melanoma. 


Discussion: The melanomata derive their name 
from their characteristic color which is due to 
the brownish or yellowish pigment contained in 
the utmor cells. The tumor occurs chiefly in 
the skin or in the subcutaneous tissue, but is also 
found in the choroid of the eye, the iris and con- 
junctiva, on the mucous membrane of the pharynx 
and rectum, and in the central nervous system. 
No portion of the surface of the body is entirely 
exempt from melanomata, but they are relatively 
frequent on the plantar aspect of the feet and 
toes, also on the extremities and on the face. 

The melanotic tumors are among the most 
malignant forms known and not only involve the 
lymph nodes very early but also invade the blood 
vessels and form metastases throughout the body, 
enormous masses occurring especially in the liver, 
also in the pleural, pericardial, and peritoneal 
cavities, and especially the bladder. They are 
fortunately rather rare, forming only about one- 
half of one per cent of malignant growths. 

Macroscopically the tumors are interesting in 
showing a great variation in the amount of pig- 
ment. The primary tumor and its metastasses 
may be coal black. The tumor may be mottled 
brown and white or may contain only a few dark 
areas. The metastasis from a perfectly black 
tumor may be white or metastasis from a light 
tumor may be intensily pigmented. The nature of 
the pigment is not fully understood. 

Microscopically the early metastases resemble 
very closely the tissue from which they have 
been derived, that is, they are found to con- 
tain small masses of oval or spherical cells with 
large vesicular nuclei, sometimes double. These 
cells may or may not be separated from each 
other by connective tissue. About and among 
them may be scattered pigmented connective tissue 
cells. 

Treatment: Removal of all pigmented moles. It 
is perhaps over emphasized, but it should be re- 
membered that it is possible for these types of 
moles to become malignant. Therefore, whenever 
a mole is subject to constant irritation, it should 
be removed. The frequency of involvement of 
regional lymph glands in malignant melanoma 
of the skin and instances of patients surviving 10 
years after removal of the glands, confirms the 
desirability of attacking the glands along with 
the primary treatment. These types of tumors 
are but little affected by radiation. Wide dis- 
tribution often follows the application and the 
same is true of the results of caustics, fulguration 
and freezing. Surgery, therefore, is the only 
treatment for melanotic tumors, and the excision 
must be early and wide and must include the 
regional lymph nodes. 


LOUISIANA STATE ME D1CAL SOCIETY NEWS 

H. Theodore Simon. M. D.. Associate Editor. 


SPECIAL NOTICE. 

There is considerable demand for back numbers 
of the Journal previous to the year 1855. The 
Journal would respectfully ask that anyone having 
these back numbers send them to this office at 
once. 


AVOYELLES PARISH MEDICAL SOCIETY. 
Head of State Doctors, A Friend to His Profession. 
Dr. S. C. Barrow, President of State Medicos 
Makes Timely Talk to Avoyelles Medical Society. 

(Reprint of Weekly News, Marksville, La., 
August 1, 1931). 

The Avoyelles Parish Medical Society held its 
quarterly meeting and “Annual Ladies Meet” at 
Marksville, Wednesday night, July 22. The wives 
of the local members, including Mrs. S. C. Barrow 
of Shreveport and Mrs. J. H. Landrum as guests 
joined in the dinner at the Mayer’s Hotel, after 
which they were entertained to a Movie Show at 
the Palace Theater, while the doctors repaired to 
the Court Building where they held a short pro- 
gram followed by an address given them by Dr. 
S. C. Barrow, eminent Radiologist of Shreveport 
and President of the State Medical Association. 
Besides Dr. Barrow, Dr. J. H. Landrum, Councillor 
from the Eighth District and Dr. Gordon Morgan 
of Melville were guests at the meeting. Dr. R. G. 
Ducote, President, presided. The following mem- 
bers of the Avoyelles unit answered the roll call: 
Drs. Emil Regard, K. A. Roy, W. F. Couvillon, S. 
J. Couvillon, Sylvin de’Nux, A. M. Haas, W. A. 
Quirk, H. C. Jones, A. T. Barbin, L. D. Lafargue, 
J. L. Pittman and R. G. Ducote. 

Dr. Barrow’s address was a masterpiece of lan- 
guage and thought, proved very timely and from 
the expressions of the local physicians in atten- 
dance, it’s evident that his talk was the most ap- 
propriate that was ever delivered along medical 
lines in Avoyelles parish. While space limitations 
prevent all what the Doctor had to say, yet this 
paper takes pleasure to quote the “high lights” of 
his address with the hope that the physicians of 
the country, as well as the public generally will 
take heed to the Doctor’s advice and warnings. 
The distinguished guest’s speech was lead by Dr. 
Walter Couvillon in discussion, followed by Drs. 
Emil Regard, de’Nux, Sam Couvillon, Haas, Pitt- 
man, Landrum and Morgan. 

Dr. Barrow discussed “Medical Organization and 
Medical Economics” and began by complimenting 
the Avoyelles medicos for their activities and num- 
bered the local unit among the “seventh most ac- 


tive medical organization in the State, as well as 
the recognized oldest rural medical society in Lou- 
isiana.” He stressed strongly “to continue to re- 
main well organized” and pointed out that in those 
parishes where a small number of physicians re- 
sided, he had advised that they join the District 
Society. 

The problem of “Medical Economics” was very 
much emphasized by the Doctor. “The time has 
come when tradition has to be violated and the 
question of finances discussed” he argued and 
“where comes the evil of discussing finances when 
the great teacher of man discussed monetary prob- 
lems in many of his parables and in none did he 
teach other than that the honest and ethical man- 
ner of distributing or acquiring money was a sin?” 
“Creeping in from all angles, insidiously and re- 
lentlessly, the Doctor’s source of income is being 
trimmed while we sit supinely by, living upon tra- 
dition.” This however, as Dr. Barrow explained 
does not mean that the “time honored and sacred 
relationship existing between the Doctor and Pa- 
tient by which their professional and business 
arrangements are mutually satisfactory, must be 
disturbed.” 

The “indigent sick” he pointed out “is a State 
and Community problem and should be met by 
the whole community and not any longer be 
shunted to the shoulders of the Medical Profes- 
sion.” “During our recent catastrophies, droughts 
and overflows in Louisiana, the indigent people 
were safeguarded by the Red Cross Society, Health 
Units and other Governmental agencies. During 
rehabilitation days the calls on local merchants to 
feed and clothe those poor unfortunates, as well 
as the replacement of homes, stock and the care 
thereof, were made good financially by those 
agencies throughout the ordeals, but when those 
poor people became sick, although it’s a matter 
of fact that the doctors of the country always 
contributed their share or more in support of all 
local, State and National charitable institutions, 
the Doctor is made to donate his only commodity, 
free medical and surgical service.” 

This, as the Doctor argued is “fundamentally, 
economically, logically, morally and in every other 
way wrong, though in line with what some would 
term Tradition.” “When the profession learns to 
be a little more deliberate in running up the flag 
‘No Charge’ in matters of medical service, where 
the whole community, the State, the Nation or 
their subdivision" owe the obligation, the problem 
at issue will become much easier to solve.” 


210 


Louisiana State Medical Society 


“The practice of our profession is our business 
and is virtually our only means of making an hon- 
orable living and deep in the hearts of every con- 
scientious physician he knows this statement to be 
true.” “He who is afraid of criticism when he 
knows he is right, lacks manhood and such a trend 
can be changed only by perfect medical organiza- 
tion and co-ordinated efforts so essential to our 
welfare and so shining an example to posterity.” 

Secretary’s Note: Dr. Barrow’s talk incited 

such keen interest with the medical men of Avoy- 
elles parish, it became necessary to secure sten- 
ographic notes and have the “essential excerpts” 
of his address published in a local newspaper. The 
talk was altogether in order and touched the hearts 
of every doctor present. From the expressions 
revealed in the discussions, it was conclusively 
proven that the Doctor touched the keynote and 
what he said was true. His attitude on this all 
important subject should be upheld by the pro- 
fession of this State — a phase in our business so 
grossly neglected. 

S. J. Couvillon, M. D., 

Secretary Avoyelles Parish Medical Society. 


BI-PARISH MEDICAL SOCIETY. 

The Bi-Parish Medical Society met in the East 
Louisiana State Hospital as the guests of Super- 
intendent Glen J. Smith and Staff. 

After a most enjoyable banquet in the spacious 
dining room of the institution, the Society went 
as a body to the Parker Hospital operating rooms 
to be entertained and enlightened by a most 
scientific address by Dr. Tom Spec Jones of Baton 
Rouge, on “The Injection Treatment of Hemor- 
rhoids.” After the address Dr. Jones demonstrated 
the simple technique on two patients of the Hos- 
pital. 

These injections may be performed in your 
office without hospitalization of your patient. 

A vote of thanks was tendered Dr. Jones for 
his instructive discourse and practical demonstra- 
tion to the physicians present. We extended a 
cordial invitation to the physicians of the States 
of Louisiana and Mississippi to be our guests at 
our regular Bi-Monthly meeting, the first Wednes- 
day at 7:30 p. m., every other month. Our next 
meeting will be in the East Louisiana State Hos- 
pital, October, 1931. 


DR. ROBERT G. DOUGLAS. 

The many friends of Dr. Robert Gibbs Douglas 
of Shreveport were shocked to hear of his death 
July 23, following several weeks’ illness. Dr. 
Douglas was born in 1885, and graduated from Tu- 
lane Medical School in 1919. Almost since the 
time of his graduation he has been connected 
with the Highland Clinic, where he devoted him- 
self solely to internal medicine. 

Dr. Douglas took an active interest in organized 
medicine. He was a regular attendant at the meet- 
ings of the State Medical Society, participated 
actively in the work of the Section on Medicine 
and Therapeutics, having presented several papers 
for this Section. He had been selected as Chair- 
man of the Section on Medicine and Therapeutics 
for next year by Dr. Barrow. In the Shreveport 
Medical Society Dr. Douglas was likewise active, 
and his ability as a medical man and his charm- 
ing personality resulted in his being elected Pres- 
ident of the Shreveport Medical Society. Dr. 
Douglas was also Chairman of the Caddo Parish 
Citizens’ Health Committee, directing and handling 
the anti-malaria campaign. 


DR. H. T. NICHOLLE. 

Dr. C. A. Weiss of Baton Rouge has sent to 
the Journal the following obituary of Dr. H. T. 
Nicholle, who died suddenly Monday, August 3, 
following a cerebral hemorrhage. 

Henry Teche Nicholle was born at Convent, 
Louisiana, in 1882, and received his medical 
education at Tulane University Medical School, 
receiving his degree in 1908. Prior to his grad- 
uation he served as an Interne at Charity Hospital 
for two years. After his graduation he specialized 
in bacteriology and pathology, in which field he 
made rapid strides and was recognized for his 
accomplishments. 

During the World War he served with distinc- 
tion, being promoted several times; his final pro- 
motion being to that of Major. 

After his service with the American Expedition- 
ary Forces, he was sent into Germany with the 
Army of Occupation. 

Six years ago he came to Baton Rouge as Bac- 
teriologist and Pathologist at Our Lady of the 
Lake Sanitarium, where he soon gave evidence 
of his ability and his pre-eminent knowledge of 


Louisiana State Medical Society 


211 


bacteriology and pathology. Under his guidance 
this department reached a high degree of effi- 
ciency. 

One of the outstanding accomplishments was 
his organization of the monthly Clinical-Pathol- 
ogical Conferences of Our Lady of the Lake 
Sanitarium. 

His associates will speak of his professional 
attainments, will tell of his ability. Notable as 
was his ability in his chosen and beloved profes- 
sion, even greater was his capacity for friendship, 
his passion for service. 

To his bereaved family we offer our deepest 
sympathy and assurance that the memory of his 
friendship and his kindliness of heart will endure. 

MORBIDITY WEEKLY REPORT. 

Dr. J. A. O’Hara, in collaboration with the 
United States Public Health Service, of the 
Treasury Department, has issued weekly mor- 
bidity reports from Louisiana which are ab- 
stracted briefly below. 

During the week ending July 18, the outstanding 
illnesses reported have to do with pellegra and 
syphilis. Of the former, 325 cases were reported, 
and of the latter 173. For the week ending July 
25, pneumonia led all other reportable diseases, 
77 being reported, and followed in order by syph- 
ilis 73, pulmonary tuberculosis 63, typhoid fever 
48, and pellegra 42. For the week ending August 
1, the reportable pneumonia cases had fallen to 
49 and tuberculosis to 32. Syphilis had increased 
to 95 cases and typhoid fever to 73, 35 of which 
were reported in the Parish of Orleans and 32 of 
these were “imported” cases going to the Charity 
Hospital. For the week ending August 8, 50 cases 
of pulmonary tuberculosis were reported, 52 cases 
of syphilis, 70 cases of typhoid fever, and 35 cases 
of pneumonia. Of the typhoid fever cases, 16 
came from the City of New Orleans, again a ma- 
jority being “imported” cases, and 10 came from 
the Parish of West Carroll. Diphtheria, scarlet 
fever, small pox, and other contagious diseases 
were reported only in a very small number. The 
same statement holds true for these diseases in 
the morbidity weekly reports for the week ending 
August 15. There were, however, 50 cases of 
typhoid reported, 10 from the Parish of Caddo, 6 


from West Carroll, and 7 from Avoyelles. During 
this week there were only 11 cases of pellegra 
reported, 26 cases of pulmonary tuberculosis, and 
20 cases of pneumonia while 59 cases of syphilis 
were reported. 


POST GRADUATE INSTRUCTION. 

The New York Academy of Medicine has sent 
out circulars describing their fourth annual grad- 
uate fortnight of instruction. The two weeks’ 
course that has been arranged seems most attrac- 
tive. There will be clinics and lectures devoted 
primarily to disorders of the circulation, but in 
addition to this course there will also be given at 
the Mount Sinia Hospital additional lectures, in- 
cluding the two Janeway lectures, both of which 
will be given by Sir Thomas Lewis of London. 
The programs and the information concerning 
registration for this course are on file in the 
Journal office. 


HEALTH OF NEW ORLEANS. 

The Division of Vital Statistics of the United 
States Department of Commerce has reported for 
the week ending August 1, 1931, that there were 
122 deaths in the City of New Orleans, giving the 
low death rate of 13.6. Sixty-seven of these 
deaths occurred in the white and 55 among the 
colored race. For the week ending August 8, 
there were 128 deaths in the City of New Orleans, 
78 among the white, and 50 among the colored, 
giving the death rate of 14.3. Thirteen of these 
deaths were in children under one year of age. 
The number of deaths and the proportion among 
the two races during this week was practically 
the same as the corresponding week of 1930. 


NEWS ITEMS. 

President S. C. Barrow spent Friday, August 21, 
in New Orleans for the purpose of going over 
official State business with Secretary-Treasurer 
Talbot. Dr. Barrow also attended the Journal 
Committee held at 7 :30 P. M. the same day. 


Dr. Leon J. Menville has been elected an honor- 
ary member of the “Pi Gamma Mu,” National 
Social Science Honor Society. 


MISSISSIPPI STATE MEDICAL ASSOCIATION NEWS 

L. S. Lippincott, Editor 

Jacob S. Ullman, Associate Editor D. W. Jones, Associate Editor 


THAT WE MAY KNOW EACH OTHER BETTER. 

Dr. Clyde Madison Speck, New Albany, Vice- 
President of the Mississippi State Medical Associa- 
tion, was born July 22, 1887, at Blue Spring's, the 
son of P. M. and Dona A. Speck. He attended 
Mississippi Heights 
Academy and received 
his degree in medicine 
from the Vanderbilt 
University Medical De- 
partment in 1912. He 
was licensed to practice 
medicine in Mississippi 
in 1910. Dr. Speck 
married Carrie C. 

Mayes, January 31, 

1916, and has one 
daughter, Carolyn, born 
March 31, 1921. 

Dr. Speck first en- 
gaged in medical rac- 
tice at Blue Springs 
where he remained un- 
til 1917, then entering 
the medical department 
of the Army, as a First 
Lieutenant. He served 
in succession at El 
Paso, Texas, with the 
10th Field Hospital, at 
the Base Hospital at 
Fort Sam Houston, at 
Camp Newton D. 

Baker, San Antonio, at 
Camp Tarvis, El Paso, 
and as Commanding 
Officer of Ambulance 
Company, No. 72 with 
the 18th Division. He 
received his discharge 
from the Army in 1918, 

Dr. Speck returned to general practice at New 
Albany and was connected with the Mayes Hos- 
pital as assistant surgeon until 1927 when he or- 
ganized the New Albany Hospital and Clinic, Inc., 
and was elected secretary. He is physician and 
surgeon, United States Bureau of Pensions, a 
member of the Northeast Mississippi Thirteen 
Counties Medical Society, the Mississippi State 
Medical Association, Southern Medical Associa- 
tion. and a fellow of the American Medical Asso- 
ciation. He was this year elected secretary and 
treasurer of the Mississippi State Hospital Asso- 


ciation and is field examiner for the Veterans 
Bureau for the State of Mississippi. He is a 
Mason and a Shriner and a member of the Kiwanis 
Club of New Albany. 


CALENDAR. 
September 1: Clai- 

borne County Medical 
Society, 3 p. m.; Staff 
of King’s Daughters’ 
Hospital, Brookhaven, 
7:30 p. m. 

September 2 : Staff 

Hospital, Natchez; 
Staff of Vicksburg In- 
fi r m a r y, Vicksburg, 
7:30 p. m.; Staff of 
Rush’s Infirmary, Me- 
ridian, 7 p. m.; Staff 
of Dr. F. G. Riley’s 
Children and Maternity 
Hospital and Clinic, 
Meridian, 7 p. m. 

September 3 : Pike 

County Medical So- 
ciety, McComb, 7:30 
p. m. 

September 4 : Nat- 

chez Medical Club, 1 
p. m. 

September 7: Jack- 

son County Medical So- 
ciety, 7:30 p. m.; Staff 
of Jackson County Hos- 
pital, 7:30 p. m.; Staff 
of Meridian Sani- 
tarium, 7 p. m. 

September 8 : Issa- 

quena-Sharkey-Warren 
Counties Medical So- 
ciety, Y. M. C. A., Vicksburg, 7 p. m. ; Staff of 
Natchez Sanatorium, 7 p. m. ; Tri-County Medical 
Society, Monticello, 12 noon; Winston County 
Medical Fraternity, Louisville. 

September 9: Staff of King’s Daughters’ Hos- 

pital, Greenville, 7 p. m. 

September 10: Staff of Vicksburg Sanitarium, 

6:30 p. m. ; Staff of Vicksburg Hospital, 7:30 p. m. 

September 11: Staff of Anderson Infirmary, 

Meridian, 7 p. m. 

September 15: Staff of Natchez Charity Hos- 

pital, 8 p. m. ; North East Mississippi Thirteen 
Counties Medical Society, 2 p. m. 



CLYDE MADISON SPECK, M. D. 
New Albany, Miss. 

Vice-President, Mississippi State Medical 
Association. 




Mississippi State Medical Association 


213 


September 18: Natchez Medical Club, 1 p. m. 

October 1 : Pike County Medical Society, Mc- 

Comb, 7 :30 p. m. 

October 2: Natchez Medical Club, 1 p. m. 

October 5: Staff of Jackson County Hospital, 

7:30 p. m. ; DeSoto County Medical Society, Her- 
nando, 10 a. m.; Staff of Meridian Sanitarium, 

7 p. m. 

October 6: Homochitto Valley Medical So- 

ciety, Natchez, 1 p. m. ; Staff of King’s Daughters’ 
Hospital, Brookhaven, 7:30 p. m. ; Annual Meeting 
of 8th Councilor District, Natchez. 

October 7 : Staff of Chamberlain-Rice Hospital, 

Natchez; Staff of Vicksburg Infirmary, 7:30 p. m.; 
Staff of Rush’s Infirmary, Meridian, 7 p. m. ; Staff 
of Dr. F. G. Riley’s Children and Maternity Hos- 
pital and Clinic, Meridian, 7 p. m. 

October 8: Staff of Vicksburg Hospital, 7:30 

p. m. 

October 9 : Staff of Anderson Infirmary, Meri- 

dian, 7 p. m. 

October 10: Staff of Vicksburg Sanitarium, 

6:30 p. m. 

October 13: Issaquena-Sharkey-Warren Coun- 

ties Medical Society, Y. M. C. A., Vicksburg, 7 
p. m. ; Staff of Natchez Sanatorium, 7 p. m. ; Wins- 
ton County Medical Fraternity, Louisville. 

October 14: Staff of King’s Daughters’ Hospi- 

tal, Greenville, 7 p. m.; Delta Medical Society, 
Moorhead, 2 p. m. 

October 15: East Mississippi Medical Society. 

October 16: Natchez Medical Club, 1 p. m. 

October 20: Staff of Natchez Charity Hospital, 

8 p. m. 

November 2: Staff of Jackson County Hospi- 

tal, 7:30 p. m. ; Staff of Meridian Sanitarium, 7 
p. m. 

November 3: Staff of King’s Daughters’ Hos- 

pital, Brookhaven, 7 :30 p. m. 

November 4: Staff of Chamberlain-Rice Hos- 

pital, Natchez; Staff of Vicksburg Infirmary, 7:30 
p. m.; Staff of Rush’s Infirmary, Meridian, 7 p. 
m. ; Staff of Dr. F. G. Riley’s Children and Ma- 
ternity Hospital and Clinic, Meridian, 7 p. m. ; 
Clarksdale and Six Counties Medical Society, 
Clarksdale, 7:30 p. m. 

November 5: Pike County Medical Society, 

McComb, 7 :30 p. m. 


November 6: Natchez Medical Club, 1 p. m. 

November 9: Staff of Vicksburg Sanitarium, 

6:30 p. m. 

November 10: Issaquena-Sharkey-Warren Coun- 
ties Medical Society, Y. M. C. A., Vicksburg, 7 
p. m.; Staff of Natchez Sanatorium, 7 p. m. ; Wins- 
ton County Medical Fraternity, Louisville. 

November 11: Staff of King’s Daughters’ Hos- 

pital, Greenville, 7 p. m. 

November 12: Staff of Vicksburg Hospital, 

7 :30 p. m. 

November 13: Staff of Anderson Infirmary, 

Meridian, 7 p. m. 

November 17 : Staff of Natchez Charity Hos- 

pital, 8 p. m. 

November 20 : Natchez Medical Club, 1 p. m. 

December 1 : Claiborne County Medical So- 

ciety, 3 p. m. ; Staff of King’s Daughters’ Hospital, 
Brookhaven, 7 :30 p. m. 

December 2: Staff of Chamberlain-Rice Hospi- 

tal, Natchez, Staff of Vicksburg Infirmary, 7 :30 
p. m. ; Staff of Rush’s Infirmary, Meridian, 7 p. 
m. ; Staff of Dr. F. G. Riley’s Children and Ma- 
ternity Hospital and Clinic, Meridian, 7 p. m. 

December 3 : Pike County Medical Society, 

McComb, 7:30 p. m. 

December 4: Natchez Medical Club, 1 p. m. 

December 7 : Jackson County Medical Society, 

7:30 p. m. ; Staff of Meridian Sanitarium, 7 p. m. ; 
Staff of Jackson County Hospital, 7 :30 p. m. 

December 8: Joint Meeting of the Fifth Dis- 

trict Medical Society of Louisiana and the Issa- 
quena-Sharkey-Warren Counties Medical Society, 
Vicksburg; Staff of Natchez Sanatorium, 7 p. m. ; 
Winston County Medical Fraternity, Louisville. 

December 9 : Staff of King’s Daughters’ Hos- 

pital, Greenville, 7 p. m. 

December 10: Staff of Vicksburg Sanitarium, 

6:30 p. m. ; Staff of Vicksburg Hospital, 7:30 
p. m. 

December 11: Staff of Anderson Infirmary, 

Meridian, 7 p. m. 

December 15: Staff of Natchez Charity Hospi- 

tal, 8 p. m., North East Mississippi Thirteen Coun- 
ties Medical Society, 2 p. m. 

December 17 : East Mississippi Medical So- 

ciety. 

December 18: Natchez Medical Club, 1 p. m. 


214 


Mississippi State Medical Association 


COMMUNITY HOSPITALS. 

During the recent political campaign, many of 
the many candidates stated that they were in 
favor of providing free beds for poor patients in 
every county hospital. Their ideas were somewhat 
at variance as to detail of ways and means. 

At the recent meeting of the State Association 
at Jackson a resolution was adopted which pro- 
vided for the appointment of a committee “To 
inform the public on the importance of this prob- 
lem during the present campaign, in which a 
governor and members of the legislature are to 
be selected; to advise with the offer of assist- 
ance to our next legislative body in making the 
proper distribution of the state charity funds for 
hospitals; and to see that the hospitals measure up 
to the standards that will provide safety to the 
public.” 

This resolution was adopted without discussion 
and therefore the members of the House of Dele- 
gates, and the profession generally, are unin- 
formed as to what is a proper distribution of the 
state charity funds for hospitals. In such places 
as Columbus, Hattiesburg, McComb, New Albany, 
Oxford and Philadelphia there are two hospitals. 
Does this committee intend to give to both insti- 
tutions in these towns? Or if to but one how is 
the distinction to be made? Would it not be well 
to publish, at an early date, the standards by 
which the hospitals are to be measured? 

The fund provided by the State at the present 
for the state charity hospitals is about a dollar a 
day per patient. The cost of caring for the pa- 
tient in the small hospitals is not less than four 
dollars per day. Who is going to put up the other 
three dollars? Is the State to be asked to adopt 
a plan of caring for its indigent sick that will cost 
at least four times as much as its present method 
is costing? 

This is not a defense of the state hospitals as 
at present maintained. In the first place the five 
state hospitals are located in a belt that extends 
from the Mississippi river at Vicksburg and 
Natchez to the eastern border of the state at 
Meridian and Laurel, thus leaving the whole north- 
ern half and the far southern section of the state 
out of reach in the case of emergencies. Sec- 
ondly, for the past twenty-five years or more it 
has been the custom for each new governor to 
appoint a new board of trustees for each state 
institution. For many years it has been an ac- 
cepted fact that the new board would appoint a 
new superintendent, who must be a surgeon. It is 
obvious that these constant changes dictated by 
political motives have interferred with the build- 
ing up of an adequate staff at these institutions. 
As a matter of fact, in the majority of cases the 


superintendent has been more interested in doing 
surgery than he has been in superintending. It is 
evident, too, that in a hospital of a hundred beds 
or more where the superintendent in addition to 
caring for the business management of the hos- 
pital, must eat and sleep, it is a physical im- 
possibility to give proper attention to all of the 
patients in an institution of this size. And it is 
equally evident that the direction and supervision 
of an intern staff without the aid of a visiting 
staff requires just as much of the superintendent’s 
time as if he were to do the work himself. 

On the other hand, it is a well known fact 
that in efficiently managed hospitals the per 
capita cost per day decreases as the number of 
patients cared for increases. At the present time 
much is being said about the cost of diagnosis 
and treatment, which has already mounted to an 
alarming figure. Will these small community hos- 
pitals be prepared to make a thorough diagnostic 
study at a cost that may be born by the average 
man? 

The questions asked above, it seems, should 
be given long and earnest consideration before the 
committee presents this matter to the Legislature. 
These smaller hospitals need aid as much as the 
five state institutions but unless the medical pro- 
fession is prepared to offer a plan that will work 
smoothly and fairly for all hospitals and for the 
public we are more than likely to have forced on 
us some ill-considered plan prepared by a layman, 
which may prove to be another path leading to 
state medicine. 

It is suggested that the Committee on Com- 
munity Hospitals make a study of this matter be- 
fore the Legislature meets. Let them study the 
plans for operating hospitals in Texas and Minne- 
sota. With such data in hand this Committee 
would be in a position to present a bill to the 
Legislature that should be of real value. But this 
is of such importance that no report should be 
made until a modus operandi that will stand the 
test of time, and that will be fair both to patients 
and to physicians, shall have been adopted. 

J. S. Ullman. 


WE ARE MOST HAPPY TO MAKE 
THE CORRECTION. 

New Orleans Medical and Surgical Journal, 

New Orleans, Louisiana. 

Dear Sir: — 

I notice in the July issue of your Journal that 
you have me listed among the dead. I would be 
pleased to know where you got the report that I 
had passed on. I am very glad to say that I am 


Mississippi State Medical Association 


215 


still very much alive and on the staff of the South 
Mississippi Charity Hospital, Laurel, Mississippi. 
Very truly, 

.(Signed) K. R. Commack. 

Dr. K. R. Commack, 

South Mississippi Charity Hospital, 

Laurel, Mississippi. 

Dear Dr. Commack: 

• 

I am in receipt of a letter from Dr. ( .W. R. Wirth, 
Editor of the New Orleans Medical and Surgical 
Journal, enclosing a copy of a letter from you in 
regard to the reporting in the July number of the 
Journal the death of Dr. Kossuth R. Commack, 
Chicora. 

The report came to me from the Mississippi 
State Board of Health. 

I am writing to the State Board of Health today 
that the correction may be made in the records 
and I shall make the correction in the next num- 
ber of the Journal. I am certainly delighted to 
know that the report was not correct. 

With all good wishes, 

Sincerely yours, 

(Signed) Leon S. Lippincott. 

cc. to Dr. W. R. Wirth 

Dr. F. J. Underwood. 


MONROE COUNTY. 

No, I am not on a vacation — money too scarce. 

My stock of energy has been at ebb-tide. My 
brain has been stupified by the oppressive heat. My 
secretary has been fully occupied meeting and 
shunting candidates, county and state. My type- 
writer does not function automatically. Besides 
all this, news might be interesting to your readers 
has been lacking. There have been no deaths, seri- 
ous sickness nor marriages in the homes of any 
of our county members. 

One thing I might mention is the fact that one 
of our most deserving and popular members has 
been given a scholarship in a postgraduate course 
— namely Dr, B. C. Tubb of Smithville. This 
scholarship is one of five allotted to Mississippi by 
a fund in New York. The course is for four 
months and to be taken at Tulane. 

Speaking of vacations I will say that only one 
of our fraternity in this county has indulged in 
such a luxury, — namely, Dr. M. Q. Ewing. He is 
away at present, perhaps at Miami or Savannah. 
I think he stated that there is nothing doing in his 
line and that he can live as cheaply one place as 
another. Really I think the supply of appendices 
has been exhausted by him, Dr. Philpot and Dr. 


Kirk of Tupelo. They may have to wait until an- 
other crop is grown. However, I discovered one 
individual in the person of a beautiful young lady 
who has escaped so far. I advised and persuaded 
her to hold hers fast for awhile longer, reminding 
her that the right ureter was in such close prox- 
imity to the appendix that not every right 
abdominal distress was due to a “chronic” appen- 
dix. In fact I told her that I had heard one of 
the nation’s surgical authorities express doubt as 
to there being such an entity as a chronic appen- 
dix. I have run out of soap — goodbye. 

G. S. Bryan, County Editor. 


DR. I. T. WOODRUFF. 

Dr. I. T. Woodruff, graduate of Memphis Hos- 
pital Medical College, class of 1893, died July 11, 
at his residence near Courtland. The cause of 
death was pulmonary tuberculosis, from which 
he had suffered for about twenty years. 

Dr. Woodruff practiced medicine a few years in 
DeSoto County, but most of his professional career 
was spent in his native county, Panola, practicing 
in Courtland, then moving to Batesville several 
years ago, where he lived until his health failed 
and he moved to his farm near Courtland. 

Dr. Woodruff made numerous friends among his 
large practice and his death is mourned by all. 
He leaves a devoted wife, one brother, and several 
sisters who miss his kindly presence among them. 

G. H. Wood, County Editor. 


HISTORY OF THE MISSISSIPPI STATE 
MEDICAL ASSOCIATION (Continued). 

Any additions or corrections will be appreciated 
by the Historian, Dr. E. F. Howard. 

1913. — The following year we find the Associ- 
ation preparing to honor a former member who, 
since leaving Mississippi, had been successful in 
throwing additional light on a problem peculiarly 
interesting to the South. Dr. C. C. Bass’ recent 
studies of the malarial parasite and his applica- 
tion of the information thus acquired in the con- 
trol of the disease had added materially to our 
knowledge and in recognition of his services the 
Association voted him a medal, which was pre- 
sented at the 1914 meeting by Dr. J. S. Ullman. 

1914. — At the forty-seventh Annual Session 
efforts were made to abandon the Insurance Reso- 
lutions passed in 1907 and to abolish the defense 
feature established in 1911, but both rode the 
storm successfully. 

An interesting bit of attempted discipline was 
shown in the introduction of a motion declaring 


216 


Mississippi State Medical Association 


vacant the office of Councilor in three districts, 
for failure in the performance of duty. 

A well-deserved tribute was paid the Associa- 
tion’s best beloved member by electing Dr. H. L. 
Sutherland of Rosedale an honorary member, the 
first to be so honored. 

1915. — The 1915 Annual Session, held in Hat- 
tiesburg, is chiefly of note in that then was first 
agitated the question of a State Hospital for tuber- 
culous patients. A general committee was ap- 
pointed to present the matter to the Legislature 
and given full authority to invoke the support of 
the Association, through the county societies. 

An interesting example of the power of organ- 
ized medicine is shown in the reports of the Coun- 
cil. The Secretary of the Southern Medical As- 
sociation had been extremely lax in the matter of 
requirements for membership in that body, accept- 
ing Mississippi physicians who were not members 
of the State Association. Complaint having been 
filed, the Southern’s Secretary admitted jurisdic- 
tion of the State Council and, proof having been 
made, agreed to comply with regulations in future. 

The chief attraction of this meeting was the 
presence of Dr. Rudolph Matas of New Orleans 
who appeared before the surgical section and also 
delivered the oration, choosing as his subject one 
on which he was eminently qualified to speak: 
“The Soul of the Surgeon.” 


LOWNDES COUNTY. 

Dr. C. E. Lehmberg, Captain, Medical Depart- 
ment, 178th Field Artillery, has just returned 
from encampment at Camp Knox, Kentucky. 

Dr. E. Q. Withers and wife are enjoying a vaca- 
tion on the Caribbean Sea. Dr. Withers is eye, 
ear, and throat man of the Fite Hospital staff. 

Dr. John E. Davis left a few days ago for New 
York City where he expects to combine business 
with pleasure. 

Dr. Eli Staton of the Columbus Hospital staff 
has returned with Mrs. Staton from a pleasant 
vacation. 

The North East Mississippi medical men are 
proud of the selection of Dr. J. M. Acker of Aber- 
deen to be president of the Mississippi Medical 
Association and predict for him a most creditable 
administration. 

J. W. Lipscomb, County Editor. 


PIKE COUNTY. 

Dr. L. D. Dickerson, proprietor and manager of 
the McComb City Hospital, died June 4, last. 
Immediately following the death of Dr. Dickerson, 
Mrs. Dickerson, even with her grief-laden heart, 


took over the management of the hospital, and 
while no one could fill Dr. Dickerson’s place in the 
hospital any more than they could fill his place in 
his church, and in the community, she has certainly 
caused harmony and good fellowship among the 
doctors connected with the hospital, and among 
the patrons of the hospital, to be the ruling “Key- 
stone.” 

Dr. R. H. Brumfield, our very efficient Secre- 
tary of the Pike County Medical Society, will leave 
August 6, for Rochester, Minn., where he will 
spend the next three or four weeks attending the 
Mayo Clinic. 

The June meeting of the Pike County Medical 
Society would have been on Thursday, June 4, 
but as this was the day that Dr. L. D. Dickerson 
died, the President had the Secretary call the 
meeting off. The membership roll still represents 
100 per cent of the practicing physicians of Pike 
County. We have 24 active members in the 
Society. At the July meeting, which was held on 
July 2, there were present, 21 members. This, of 
course, included the two new members who joined 
the Society that night. Of course, we don’t have 
as large attendance at every meeting, yet I think 
we still hold the Blue Ribbon for membership roll 
percentage and for attendance average. 

The Pike County Health Unit, under the super- 
vision of the “Commonwealth Fund” and with Dr. 
T. Paul Haney as director, opened for business, on 
July 1, with headquarters at McComb, and offices 
on the second floor of the city hall. 

Everyone is expecting the health unit to accom- 
plish great good, and they should if they get the 
right sort of co-operation from the doctors of Pike 
County, and they will get it — if they give that 
kind, and I am sure they will. The doctors of 
Pike County are just that kind of fellows, finest 
set of men to be found anywhere. 

You know, if one will watch as one goes along 
through life, one will find, with possibly a few 
exceptions, that one usually gets back just about 
the kind that one gives out. 

I. E. Stennis, 

President, Pike County Medical Society. 


PONTOTOC COUNTY. 

Dr. W. R. Card of Heth, Arkansas, has recently 
moved to Pontotoc County and is located at 
Houlka, Route 5. 

R. P. Donaldson, County Editor. 


BOLIVAR COUNTY HEALTH DEPARTMENT. 
Dr. L. B. Austin, member of the Mississippi 
State Board of Health for the third district, has 


Mississippi State Medical Association 


217 


recently received the biennial report of the Depart- 
ment of Health of Bolivar County as prepared by 
Dr. R. D. Dedwylder, Director. 

The report contains some very interesting infor- 
mation in regard to the County, its location and 
natural advantages, population and distribution, 
race proportions, industries, drainage, roads, edu- 
cational advantages, and enrollment in schools. 

The Bolivar County Health Department was 
organized in July 1920, and has been well sup- 
ported. At present the staff consists of the Di- 
rector, Dr. Dedwylder, two nurses, bacteriologist, 
technician, inspector, part time engineer, and a 
nurse and inspector paid for by the United States 
Public Health Service. Due to economic condi- 
tions, anti-mosquito work has been discontinued. 

Educational activities for the two years include 
441 lectures: public lectures, 91, and school lec- 
tures, 350; bulletins distributed, 5,276; newspaper 
articles published, 89; letters and notices, 4,926; 
reports of all kinds, 1,506; conferences, 136; other 
activities, 4,936. The total attendance at lectures 
was 19,961. 

In the control of communicable diseases 610 
general examinations were made, 487 visits were 
made, 7 carriers were isolated and 133 contacts 
quarantined. For venereal disease, 1,500 suspects 
were examined and 770 treatments given to in- 
digent cases. A total of 3,486 Schick tests were 
made of which 841 were positive. Forty Dick 
tests were made of which 8 were positive. For 
the control of bovine tuberculosis 957 cows were 
tested. For immunization 9,147 doses of, toxin- 
antitoxin mixture w^ere given; 55,667 doses of 
typhoid vaccines were given; 3,729 smallpox vac- 
cinations were made; and 215 doses of anti-rabies 
vaccine were administered. 

The laboratory of the health department is 
constantly used by all the physicians of the county. 

The special anti-malaria campaign which it was 
necessary to discontinue, included the use of a 
spot map of malaria foci and the organization of 
mosquito control work. Screening of tenant rural 
homes has been urged and 536 recorded houses 
have been screened and 1,946 standard doors in- 
stalled. A part time engineering service provides 
for the promotion of minor drainage. This work 
is very popular and the call for the services of 
the engineer is constantly increasing. 

VICKSBURG SANITARIUM AND CRAWFORD 
STREET HOSPITAL. 

The regular monthly meeting of the staT of the 
Vicksburg Sanitarium and Crawford Street Hos- 
pital was held on August 10, with nine members 
of the staff and eight guests present. 


After the business of the staff and reports from 
the records department and analysis of the work 
of the hospital, the following special reports of 
current cases were presented: 

1. Pylephlebitis with Multiple Liver Abscesses 
Following Suppurative Appendicitis. — Dr. G. M. 
Street. 

2. Carcinoma of the Stomach. — Dr. A. Street. 

3. Brain Tumor. — Dr. J. A. Birchett, Jr. 

4. Osteomyelitis, Acute. — Dr. G. C. Jarratt. 

5. Melanoma. — Dr. Walter Johnston. 

Selected radiographic studies were demonstrated 
as follows: Pulmonary tuberculosis, cholelithiasis, 
nephrolithiasis, tumor of kidney. 

Drs. S. W. Johnston and Walter Johnston pre- 
sented a moving picture on spinal anesthesia. 

The meeting closed with a lunch. 


WINSTON COUNTY. 

The Winston County Medical Fraternity meets 
the second Tuesday night of each month. 

Dr. R. L. Donald of Louisville, who came here 
the first of last month, was mentioned in last 
locals as having with him a wife. In justice to 
Dr. Donald we are pleased to correct this mistake, 
as he is a single man. 

Drs. Hickman and Hickman are adding to their 
office accommodations and preparing to meet any 
work that may come to them. 

Distressingly healthy times in this section are 
giving the doctors a time to rest and relax. 

We notice with disapproval a political reflection 
on our good servant and friend, Dr. Willis Walley 
of Jackson. We are not concerned as to his politi- 
cal alignment, but commend him most highly as 
a surgeon in the capacity he now occupies, super- 
intendent of the State Charity Hospital at Jackson. 
We have depended upon these institutions to do 
all of our charity surgery for a period of twenty 
years, and Dr. Walley has given service second 
to none. 

M. L. Montgomery, County Editor. 


ADAMS COUNTY. 

Dr. and Mrs. W. K. Stowers are visiting on the 
Mississippi coast and in Florida. 

Dr. J. S. Ullman has returned from a week-end 
visit to Gulfport. 

Dr. H. M. Smith, who for the past month has 
been at Rochester. Minnesota, for specialized work 
at the Mayo Clinic, has returned to resume his 
practice. 


L. Wallin, County Editor. 


218 


Mississippi State Medical Association 


WARREN COUNTY. 

Dr. M. H. Bell is enjoying his vacation; his 
health is improving quite markedly. 

Dr. and Mrs. L. J. Clark enjoyed a few days at 
the Mayo Clinic and in Chicago recently. 

Dr. Henry B. Goodman, son of Dr. H. S. Good- 
man, Cary, is connected with the staff of the Mis- 
sissippi State Charity Hospital at Vicksburg. 

Dr. Nathan Lewis has entered private practice, 
being associated with Dr. B. B. Martin. 

Dr. and Mrs. Preston S. Herring are being con- 
gratulated upon the arrival of a little girl. 

Edley H. Jones, County Editor. 


DEATHS OF MISSISSIPPI PHYSICIANS. 

Wilson R. Eatherly, Winterville; diabetes melli* 
tus; July 7, at Winterville. Born Leeville, Tenn., 
Feb. 14, 1857. 

L. L. Greer, McComb; appendicitis; July 11, at 
McComb. Born Ruth, Dec. 16, 1880. 

I. T. Woodruff, Batesville; pulmonary tuber- 
culosis; July 11, at Courtland. Born Panola, Oct. 
17, 1870. 

Francis V. McRee, Brookhaven; cancer; July 
17, at Brookhaven. Born Mississippi, 1871. 

William Tillman Duke, Glen Allen; sudden 
death; July 23, at Galveston, Texas. Born Mis- 
sissippi, 1890. 

James B. Britt, Blue Mountain; heart attack; 
July 28, at Blue Mountain. Born Clarysville, 
June 10, 1876. 

HOMOCHITTO VALLEY MEDICAL SOCIETY. 

On Oct. 6, at Natchez, the Homochitto Valley 
Medical Society will be host to the Tri-County and 
Pike County Medical Societies for the meeting of 
the Eighth Councilor District, which is made up 
of the counties of Adams, Amite, Copiah, Franklin, 
Jefferson, Lawrence, Lincoln, Pike, Walthall and 
Wilkinson. 

Drs. Isadore Cohn, New Orleans; T. B. Sellers, 
New Orleans, and Alphonse H. Meyer, Memphis, 
are the essayists which assures a program of un- 
usual interest. 

Dr. H. M. Smith, Natchez, spent the month of 
July at the Mayo Clinic, Rochester, Minn., and 
stopped at Birmingham a few days on his way 
home to visit the clinic of Dr. Seale Harris. 


Dr. J. Dunbar Shields, Pine Ridge, is in the 
lead as he enters the second primary campaign 
as candidate for Adams County representative to 
the State Legislature. J. S. Ullman. 


ISSAQUENA-SHARKEY-WARREN COUNTIES 
MEDICAL SOCIETY. 

The regular monthly meeting of the Issaquena- 
Sharkey- Warren Counties Medical Society was 
held at the Y. M. C. A., Vicksburg, August 11, 
with 19 members and 10 guests present. The 
scientific program included the following: 

1. Diphtheria. — Dr. A. K. Barrier, Rolling Fork. 
Discussed by Drs. F. M. Smith, L. S. Lippincott, 
E. F. Howard, H. H. Haralson, J. E. Quidor, G. M. 
Street, all of Vicksburg, and R. H. Foster, Angu- 
illa. Dr. Barrier closed. 

2. Nephrolithiasis. — Dr. G. P. Sanderson, Vicks- 
burg. Discussed by Drs. W. H. Parsons and J. A. 
K. Birchett, Jr., of Vicksburg. Dr. Sanderson 
closed. 

Drs. William Graham Weston, Vicksburg Hos- 
pital; Nathan B. Lewis, Vicksburg Infirmary, and 
Henry Brown Goodman, Mississippi State Charity 
Hospital, were elected to membership in the 
society. 

Drs. S. W. Johnston and Walter Johnston pre- 
sented a moving picture, “Spinal Anesthesia.” 

Drs. M. H. Bell and C. J. Edwards of Vicksburg 
were reported ill. 

The committee, consisting of Drs. W. H. Par- 
sons, Vicksburg; J. B. Benton, Valley Park, and 
W. C. Pool, Cary, appointed at the last meeting, 
to investigate the activities of all agencies, prac- 
ticing medicine in the three counties of Issaquena, 
Sharkey, and Warren, that are financed either in 
whole or in part from the public funds, in an 
effort to determine, if, and to what extent these 
activities are infringing on the rights and just 
privileges of private physicians, made its report, 
which included the following: 

“The administration of neoarsphenamine, there- 
fore, we consider to be practicing curative medi- 
cine. We find that in the Counties of Issaquena 
and Sharkey the County Health Officer administers 
this drug upon written order of any physician 
practicing in those counties. In the year 1930, 
541 doses were given. We disapprove of the prac- 
tice of a county health officer giving this drug 
and we feel that in this particular instance, the 
rights and privileges of private physicians are be- 
ing infringed upon. In justice, however, to the 
State Board of Health, we must state that the 
said county health officer of Sharkey and Issa- 
quena Counties gives these injections only upon 


Mississippi State Medical Association 


219 


written order of a physician of these respective 
counties. We feel, however, that the State Board 
of Health should instruct its county health officer 
to discontinue the administration of neoarsphena- 
mine and we feel that the physicians of Sharkey 
and Issaquena Counties should discontinue re- 
questing their health officer to give these injec- 
tions. We have found no instance in Warren 
County of neoarsphenamine having been given by 
its health officer. 

“Regarding the treatment of pellagra, we are 
informed by Dr. F. J. Underwood, Dr. A. K. Bar- 
rier and Dr. F. Michael Smith that pellagrins are 
given a diet list and given yeast. We believe this 
to be practicing curative medicine and we believe 
this practice to infringe upon the rights and privi- 
leges of private physicians. We recommend that 
the treatment of pellagra be discontinued. We 
do not, however, wish such recommendation to be 
construed as opposing educational work in this 
field. 

“We find that school children are examined in 
all of the three counties and this examination, so 
far as we have been able to determine, comprises 
examination of the eyes, ears, throat, heart and 
lungs and a general survey of the nutrition of the 
child. If this work is confined strictly to deter- 
mining if defects exist and in the event they do, 
recommending to the parents that they consult 
whatever reputable physician they chose, we see 
no objection to this practice except that inasmuch 
as examinations are not thorough, it should be 
clearly stated to the parents or responsible per- 
son that the examination is cursory in nature and 
does not necessarily mean that there are no de- 
fects present. 

“We find that in all three counties physical ex- 
aminations are made of food handlers and of bar- 
bers. We recognize the necessity of these exam- 
inations being made and approve of this, but we 
feel that the cost of them if made by private 
physicians would be in the nature of an occupa- 
tional tax that would be entirely proper and by 
no means prohibitive.” 

The report was adopted and the committee 
discharged. 

The meeting closed with a Dutch lunch. 


BOLIVAR COUNTY. 

Dr. E. R. Nobles, Rosedale, attended a meeting 
of the Committee of the Mississippi State Medical 
Association on Community Hospitals held in Jack- 
son in July. 

Dr. S. W. Colquitt, Beulah, spent his vacation 
in Magnolia, Stamps, and Hope, Arkansas, ming- 
ling with relatives and boyhood friends. 


Dr. J. E. Williams, Benoit, must have been ill 
during the month of July as he was absent at 
one dance. Hope he has recovered. 

Dr. C. W. Patterson, Rosedale, was called to the 
bedside of his mother who is critically ill and not 
expected to recover. 

The next meeting of the Delta Medical Society 
will be at Moorhead, October 14, at 2 P. M. 

C. W. Patterson, County Editor. 


PONTOTOC COUNTY. 

Beginning July 20, last, Dr. J. R. McCord of 
Emory University, Atlanta, gave a five day lecture 
series on the general subject of obstetrics under 
the direction of the Mississippi State Board of 
Health, at the Methodist Church, New Albany. 
Lectures began at two P. M. and lasted until five 
P. M. In all, twenty-six doctors from the sur- 
rounding counties attended. Pontotoc County had 
three doctors in attendance. They were Dr. Z. A. 
Dorsey, Troy; Dr. J. H. Windham, Ecru, and Dr. 
Eliam B. Burns, Ecru. These lectures were con- 
cise but comprehensive. They covered normal 
and pathological obstetrics. This was a very 
helpful course and will serve to raise the stand- 
ard of obstetrical practice in this part of the State. 
We were very fortunate in getting this fine set of 
lectures from the State Board of Health. 

There is no sickness of any consequence among 
our doctors to report. 

Most of us are recovered from the severe at- 
tack of “politicitis“ which has had us for the last 
several weeks. Soon we will return to the normal 
again. Eliam B. Burns, County Editor. 


YAZOO COUNTY. 

Election is over and everything quiet. Dr. H. 
L. McCalip, Yazoo City, has just returned from a 
two weeks’ trip with the National Guard at Camp 
Beauregard, Louisiana. 

Drs. Darrington, Swayze, W. D. McCalip, Coker, 
and Roberts attended the recent joint meeting 
of the Central Medical Society and the Issaquena- 
Sharkey- Warren Counties Medical Society at 
Vicksburg. Had a good time. Dr. John Darring- 
ton made a short visit to Dr. Smithson, who is con- 
valescing, we are glad to hear. Hope for a speedy 
recovery. 

C. M. Coker, County Editor. 


JACKSON. 

Dr. H. R. Shands is taking his vacation in Cali- 
fornia. At last accounts, he was at Hollywood. 
We do not know whether he expects to appear 
in the “movies” or not. 


220 


Mississippi State Medical Association 


Dr. Frank L. Van Alstine is taking his vacation 
at Colorado Springs, where he will spend the sum- 
mer months in recuperating. 

Dr. G. C. Russell is taking his vacation at the 
Mayo Clinic, where he will study some of the 
newer methods in surgery. 

Dr. A. E. Gordin has recently returned from an 
extensive trip to Cuba and the West Indies, where 
he was the recipient of many courtesies from offi- 
cials and doctors. 

Dr. J. P. Wall and Miss Sarah King were mar- 
ried on July 25 and left for an extensive tour of 
European countries. They will visit the former 
battle fields where Dr. Wall saw service, and Mrs. 
Wall’s relatives in Ireland, where she was born. 

Dr. H. R. Hays and Dr. L. W. Long have re- 
cently returned from Camp Beauregard, where 
they attended the officers’ training school. They 
look sunburned and hearty and report that army 
life in a training camp is a great vacation. 

Dr. Brister Ware, University of Mississippi and 
Jefferson Medical College, who has spent the last 
two years as an interne in the Louisiana State 
Charity Hospital, has located here for the practice 
of general surgery and gynecology. His office is 
in the Standard Life Building. 

Dr. L. V. McCarty, University of Mississippi 
and Emory University, who spent the last year 
as an interne at Touro Infirmary, has opened an 
office in the Standard Life Building, and will en- 
gage in general practice. 

Dr. Van Dyke Hagaman, University of Missis- 
sippi and Vanderbilt, who spent an internship at 
Crile’s Clinic, in ear, nose and throat work, is 
associated with the State Charity Hospital tem- 
porarily. 

Several of our doctors are on the sick list. Dr. 

J. E. McDill is at the Baptist Hospital, undergoing 
repairs; Dr. L. B. Neal is at home recuperating 
from an overtaxed heart; Dr. William W. Smithson 
is at the Jackson Infirmary recuperating after a 
serious operation. 

Mrs. F. E. Werkheiser is at the Willis Walley 
Hospital very seriously ill but her physicians re- 
port some improvement at this writing. 

D. W. Jones. 


LECTURES ON OBSTETRICS. 

By arrangement of the Mississippi State Board 
of Health with the Children’s Bureau of the United 
States Department of Labor, lecture courses in 
obstetrics have been made available to the doc- 


tors of the State this year. The lectures are given 
by Dr. James R. McCord, Professor of Obstetrics 
at Emory University, Atlanta, Ga., and profusely 
illustrated by slides and remarkably fine motion 
pictures. 

The first course of lectures was given at New 
Albany, July 20 to 24, with the following in attend- 
ance: Drs. E. B. Burns, Ecru; J. I. Mayfield, 

Blue Mountain; R. B. Cunningham, Booneville; 
W. C. Hays, Sherman; C. M. Murry, Ripley; S. E. 
Eason, New Albany; H. P. Boswell, New Albany; 
R. H. Adams, Ripley; C. M. Speck, New Albany; 
Frank Ferrell, Ashland; R. A. Holcomb, Hickory 
Flat; Z. A. Dorsey, Troy; Jessie Mauney, Blue 
Mountain; W. F. Coleman, Hickory Flat; Joseph 
J. MacGowan, Ashland; I. B. Trapp, New Albany; 

J. W. Williams, Ingomar; H. G. Waldrop, Dumas; 
A. V. Murry, Ripley; E. H. Wesson, New Albany; 
G. F. Cullens, Wallerville; J. H. Windham, Ecru; 
T. J. Pennebaker, Cotton Plant; H. A. Stokes, Gun- 
town; J. H. Giles, Ripley; Roy Gilmer Grant, 
Holly Springs. 

The second course of lectures was given at 
Vicksburg August 3 to 7, with the following in 
attendance: Drs. H. S. Goodman, Cary; J. S. 
Ewing, Vicksburg; W. C. Pool, Cary; Felix J. 
Underwood, Jackson; S. Myers, Vicksburg; J. A. 

K. Birchett, Vicksburg; M. J. Few, Rolling Fork; 
C. C. Applewhite, Jackson; A. K. Barrier, Rolling 
Fork; T. B. Owen, Hollandale; W. P. Shackleford, 
Hollandale; R. H. Foster, Anguilla; L. Stevens, 
Tullulah, La.; G. W. Gaines, Tullulah, La.; F. M. 
Smith, Vicksburg; C. L. Simmons, Hazelhurst; 

L. S. Lippincott, Vicksburg; J. S. Davidson, Vicks- 
burg; Sidney W. Johnston, Vicksburg; H. B. Good- 
man, Vicksburg; V. O. Stewart, Anguilla; W. H. 
Scudder, Mayersville; A. M. Ragan, Edwards; Jos- 
eph Whitaker, St. Joseph, La.; E. B. Stribling, 
Rolling Fork; B. B. Martin, Vicksburg; F. A. 
Thomas, St. Joseph, La.; N. B. Lewis, Vicksburg; 
C. F. Clayton, Jr., Vicksburg; C. B. Flinn, Her- 
nando; R. N. Whitfield, Jackson; Preston Herring, 
Vicksburg; A. T. Palmer, Tullulah, La.; and medi- 
cal students, D. S. Hall and B. B. Martin, Jr., 
Vicksburg. 

Other courses now planned for Mississippi are 
in the weeks of August 24, September 28, October 
12, November 2, and December 7. If these lec- 
tures which really amount to a post-graduate 
course are successful, it is planned next year to 
bring to Mississippi a nationally known pediatri- 
cian for similar courses. There is no fee to phy- 
sicians. 

The obstetrical lectures cover the following sub- 
jects: Monday — Mechanism and Management of 


Mississippi State Medical Association 


221 


Normal Labor; Management of the Puerperium. 
Tuesday — The Toxemias of Pregnancy (Eclamp- 
sia, Chronic Nephritis) ; Prenatal Care. Wednes- 
day — Puerperal Sepsis; Syphilis and Pregnancy. 
Thursday — Breech Presentation; Version; Forceps. 
Friday — Abortion; Placenta Previa; Accidental 
Separation of the Placenta. 


FELLOWSHIPS AND SCHOLARSHIPS. 

The Mississippi State Board of Health has ar- 
ranged for 15 four months fellowships for prac- 
ticing physicians of the State. These fellowships 
pay each physician chosen $1,000 plus tuition and 
expenses to Tulane Graduate School of Medicine, 
and return, and are given by the Commonwealth 
Fund. Arrangements have also been made for five 
undergraduate medical scholarships for the sons 
of physicians and others, these scholarships to 
pay $100 a month for four years plus tuition, 
which will easily amount to $1800 during the four 
years course and making each scholarship worth 
practically $7,000. This program has been prom- 
ised for a minimum period of ten years and may 
be extended to fifteen. These fellowships and 
scholarships, with $25,000 each year paid to Tu- 
lane University to take care of Mississippi gradu- 
ate and undergraduate scholarships by the Com- 
monwealth Fund will amount to more than a mil- 
lion dollars for medical education in Mississippi 
during the next ten years. 

The following six young men have been awarded 
scholarships to enter Tulane School of Medicine 
this Fall: James G. Blaine, Clinton; Edwin M. 

Meek, West Point; Aubrey V. Beacham, Hatties- 
burg; Paul Rogers Googe, Booneville; Onie P. 
Myers, Collinsville, and Russell L. Welch, Norfield. 

The undergraduate scholarships and postgradu- 
ate fellowships awarded have nothing to do with 
public health but are simply straight-out medical 
courses. The men awarded the postgraduate 
courses will take the subjects most useful to them 
in their practice. The only purpose the State 
Board of Health and the Commonwealth Fund 
have in awarding these fellowships is to be of 
assistance to the physicians of Mississippi many, 
of whom are unable to pay for postgraduate 
courses themselves, and to improve the standards 
of medical practice in the State. 


COMMUNICABLE DISEASES. 

The Bureau of Communicable Diseases of the 
Mississippi State Board of Health reports for the 
month of June, typhoid fever, 101 cases; small- 
pox, 143; diphtheria, 22; epidemic cerebrospinal 
meningitis, 5; pellagra, 2184; tuberculosis, 163. 
Now is the time to urge and to administer typhoid 
vaccine, smallpox vaccine, and toxin-antitoxin 
mixture or toxoid. 


HONOR ROLL FOR SEPTEMBER. 

The following are contributors to the Mississippi 
Section this month: C. M. Speck, J. S. Ullman, 

K. R. Commack, G. S. Bryan, G. H. Wood, E. F. 
Howard, J. W. Lipscomb, I. E. Stennis, R. P. Don- 
aldon, L. B. Austin, M. L. Montgomery, L. Wallin, 
E. H. Jones, F. J. Underwood, C. W. Patterson, E. 
B. Burns, C. M. Coker, D. W. Jones, J. C. Pegues, 
E. E. Benoist, T. H Rayburn, A. Street, J. A. K. 
Birchett, Jr., G. C. Jarratt, W. E. Johnson, R. C. 
Finlay, T. L. Bennett, L. L. Minor, O. N. Arring- 
ton, Albert Hand, G. W. Acker, J. N. Rape, J. M. 
Acker, Jr., W. K. Stowers, R. H. Brumfield, A. H. 
Little. 

Your editors thank you. 


MISSISSIPPI STATE BOARD OF HEALTH. 

Miss Augustine B. Stoll, R. N., of New York, 
began work with the Mississippi State Board of 
Health on July 15. Miss Stoll has had much val- 
uable training and experience. She was on the 
staff of Bellevue Hospital, New York City, did 
rural public health nursing in New York, and for 
several years was Supervisor of Child Welfare 
Work in Czechoslovakia. She was on the staff of 
the Mexico Association in charge of Indian Af- 
fairs and as a nurse worked with the Indians for 
four years. Miss Stoll has just completed a post- 
graduate course in public health nursing at Co- 
lumbia University and the State Board of Health 
considers itself fortunate to be able to secure her 
services. 

Dr. J. H. Janney, Director of the Ti-aining Sta- 
tion for Health Workers at Indianola, Mississippi 
since 1928, has been transferred by the Rockefel- 
ler Foundation to Maryland. Dr. Chas. A. Bailey, 
formerly representative of the Foundation at 


222 


Mississippi State Medical Association 


Paris, France is now in charge of the Training 
Station. 

Dr. Henry Daspit, Dean of the Tulane Graduate 
School of Medicine, New Orleans, was a visitor 
at the State Department of Health offices on 
August 12. Dr. Daspit’s visit was for the purpose 
of discussing details relative to the postgraduate 
fellowships which have been awarded to fifteen 
Mississippi physicians under the Commonwealth 
Fund’s plan of co-operation with the State Board 
of Health. 

Prof. Wm. F. Wells of Harvard University, Bos- 
ton, spent two weeks with the State Board of 
Health during the month of July. Prof. Wells was 
especially interested in rural sanitation and mala- 
ria control activities of the Mississippi Health De- 
partment, and spent most of his time in the Delta 
with the full-time health departments which have 
excellent programs along the lines mentioned. 

Dr. W. A. Davis, State Registrar of Vital Sta- 
tistics, Austin, Texas, visited the State Board of 
Health offices on August 17 for the purpose of 
studying the new indexing method used by the 
Mississippi Bureau of Vital Statistics. 

Mr. H. R. Fullerton and Mr. M. F. Wooten, Jr., 
sanitary engineers, Division of Malaria Control of 
the Tennessee State Board of Health, spent the 
week of August 17 in the Delta section of Missis- 
sippi. Their visit was for the purpose of making 
observations of the Mississippi State Board of 
Health malaria control activities with special ref- 
erence to the program and results accomplished by 
minor drainage in that section of the State. 

Other visitors to the State Board of Health for 
the purpose of studying and observing health work 
in Mississippi were as follows: Dr. Frank Bane, 
State Commissioner of Public Welfare of Virginia; 
Dr. John E. Monger, Columbus, Ohio; Dr. C. P. 
Coogle, Malariologist, U. S. Public Health Service, 
Memphis, Tennessee; Mr. N. M. Cregor, Vice Pres- 
ident, Vitamin Food Company, New York, N. Y. ; 
Mr. Herbert Wilson, Washington, D. C.; Dr. Jos. 
W. Mountin, U. S. Public Health Service, Washing- 
ton, D. C.; Dr. L. L. Lumsden, Medical Officer, U. 
S. Public Health Service, Washington, D. C. ; Dr. 
Taliaferro Clark, Representative, Julius Rosen- 
wald Fund, U. S. Public Health Service, Wash- 
ington, D. C. 


A COMMUNICATION. 

Dr. Leon S. Lippincott, Secretary 

Issaquena-Sharkey-Warren Counties 
Medical Society 
Vicksburg, Mississippi. 

Dear Dr. Lippincott: 

Agreeable to my promise to you the other 
night, I am enclosing a copy of American Medical 
Association resolution. Under this resolution, Dr. 
Barrier has not been guilty of over-stepping his 
bounds for the reason that the physicians within 
his jurisdiction had a meeting more than a year 
ago agreed upon the program which he has car- 
ried out since that time. 

While the resolution passed by the Issaquena- 
Sharkey-Warren Counties Medical Society at its 
last meeting is in line with the general policy of 
the State Board of Health, I feel that if it is pub- 
lished in the New Orleans Medical and Surgical 
Journal without the American Medical Associa- 
tion’s definition of “state medicine” and without 
an explanation that the physicians within Dr. Bar- 
rier’s jurisdiction met and agreed upon a plan 
whereby he was to treat indigent cases of syphilis, 
that it would be unfair and unjust to the Issa- 
quena-Sharkey Counties Health Officer and to the 
State Board of Health. 

Dr. Benton of Issaquena County and Drs. 
Goodman and Pool of Sharkey County all stated 
at the Committee Hearing on August 6 that Dr. 
Barrier was doing exactly what the local medical 
group in Sharkey and Issaquena Counties had 
agreed for him to do and that they had no critic- 
isms to offer. 

* * * * * 

With best wishes, I am 

Very truly yours, 

(Signed) Felix J. Underwood. 


THE DEFINITION. 

“ ‘State medicine’ is hereby defined for the pur- 
pose of this resolution to be any form of medical 
treatment, provided, conducted, controlled, or sub- 
sidized by the federal or any state government, or 
municipality, excepting such service as is provided 
by the Army, Navy, or Public Health Service, and 
that which is necessary for the control of com- 
municable disease, the treatment of mental disease, 
the treatment of the indigent sick, and such other 
services as may be approved by and administered 
under the direction of or by a local county medical 
society of which it is a component part. — Resolu- 
tion passed by the American Medical Association 
at its annual meeting in 1922.” 


BOOK REVIEWS 


Text Book of Physical Therapy: By William Ben- 
ham Snow, M. D. New York, New York Scien- 
tific Authors’ Publishing Company. 1931. 
pp. 708. 

This book presents an enormous amount of 
material, and is divided into 3 sections. The 
first section, “Constant Current and Static Cur- 
rent,” has 20 chapters dealing with the applica- 
tion of this kind of current in the treatment of 
disease. 

The second section, “High Frequency Currents,” 
explains the development, physics, physical effects, 
physiological effects, and the therapeutics of high 
frequency current in its application in the treat- 
ment of many diseases. There are 15 chapters to 
this section. 

The third section, “Electrosurgery,” elaborates 
upon the development and accomplishments of 
electrosurgery and includes its application to the 
treatment of diseased tonsils, hemorrhoids, etc. 
There are 8 chapters in the last section of this 
book. 

According to the text, nearly every known 
disease is susceptible of treatment by physical 
therapy. 

Leon J. Menville, M. D. 


Textbook of Histology: By Eugene C. Piette, M. 

D. Philadelphia, F. A. Davis Company. 1931. 
pp. 466. 

The reader of this work will be impressed by the 
compactness of its treatment of histology, and by 
the manner in which both practical applications 
of this subject and the correlation of structure and 
function are introduced. Dr. Piette has sought 
to make a concise text, and this he has done with- 
out injecting the atmosphere of a compend. It is 
distinctively a practical textbook, and it may be 
noted that the author’s association with pathology 
is of eminent importance in this connection. The 
typographical arrangement, including headings and 
bold-faced printing of key words, provides an effec- 
tual aid in reading. 

Harold Cummins, Ph. D. 


Preparation of i Scientific and Technical Papers: 
By Bam F. Trelease and Emma S. Yule. 
Baltimore, Williams & Wilkins. 1930. pp. 117. 

This handbook, a reprint of the second edition 
(1927), is a convenient and very valuable guide 
to the writing of a paper in any field of the exact 


sciences. Though primarily designed for the use 
of students, the book will be equally serviceable 
as a reference book to the professional man who 
has occasion to do scientific writing. 

Charles Midlo, M. D. 


Streptococcic Blood Stream Infections: By George 
E. Rockwell. New York, Macmillan Company. 
1931. pp. 73. 

In this treatise the author has succeeded in giv- 
ing a succinct account of the phases of physiology, 
pathology, chemistry, and bacteriology concerned 
in streptococcic blood stream infections. The facts 
derived from these basis sciences are then lucidly 
applied to explain the rationale of the measures 
employed in the diagnosis, management, and treat- 
ment of the streptococcic blood stream infections. 

In an appendix, the intravenous use of mercuro- 
chrome, gentian violet, and sodium ricinoleate is 
critically reviewed. 

There is a comprehensive index. 

Charles Midlo, M. D. 


Introduction to Medical Biometry and Statistics: 
By Raymond Pearl. 2nd rev. ed. Philadel- 
phia, W. B. Saunders Co. 1930. pp. 459. 

A second edition of a book already considered 
a medical classic. It is of inestimable value to one 
interested in the quantitative aspects of the medi- 
cal subjects and statistical studies. Its one un- 
fortunate circumstance is the great amount of 
mathematics and mathematical formulae neces- 
sarily employed but which is terra incognita to 
the majority of physicians. 

I. L. Robbins, M. D. 


Abdomino-P elvic Diagnosis in Women: By Arthur 
John Walscheid, M. D. St. Louis, C. V. Mosby 
Company. 1931. pp. 1000. 

In his text Dr. Walscheid steps out of the usual 
form of texts, and approaches the subject from a 
different point of view. Part one deals with anato- 
mical considerations, normal and abnormal. The 
chapter on anthropology, as a rule not considered 
in texts on gynecology, is fully covered. 

The systematic arrangement of a part dealing 
with general causal factors, pathologic processes, 
symptoms and diagnosis and the second pai't deal- 
ing with individual organs from the standpoint 


224 


Book Reviews 


of pathology and diagnosis, together with illus- 
trative cases makes it an excellent reference text. 
It will be observed that only allusions are made to 
some special treatments but an attempt is made 
to consider this point of view. There are a good 
many illustrations to emphasize pathological speci- 
mens. 

Adolph Jacobs, M. D. 


The Criminal, the Judge and the Public: By 
Franz Alexander, M. D., and Hugo Staub. 
New York, The Macmillan Co. 1931. pp. 
238. 

The title of this book for review could well be 
termed “The Mind and the Law.” This is writ- 
ten in two parts and translated from the German 
by a graduate physician, psychoanalysist, and an 
attorney-at-law. 

Apparently very little has been lost in the 
translation as regards subject matter. For the 
most part it is in an entirely psychoanalytic vein 
with interpretations, explanations and descriptions 
in keeping with psychoanalysis. It is decidedly 
socio-medico-legal in context. The criminalistic 
tendencies in the normal and the criminal are 
microscopically examined. There is much concern- 
ing the application of justice to these cases and 
the methods, means and manner by which they 
may be approached. The question of sexual 
psychopathy is entered into (the examiner thinks 
this a more scientific term to use), with great 
detail and should be instructive to the lawyer 
as well as those heading social problems. 

Then follows a description of celebrated cases 
in which psychoanalysis was used to aid them in 
their difficulties and then follows psychology of 
punishment. This is replete with psychoanalytic 
explanations. 

Psychiatrists, alienists should do well to read 
this. It should likwise make substantial collateral 
reading for child guidance directors and men- 
tally equipped social workers. 

The question of analysis of the subject, in the 
examiner’s opinion, should only be done by a 
graduate, qualified physician, preferably in all 
instances a psychiatrist. 

Walter J. Otis, M. D. 


The Infant Welfare Movement in the Eighteenth 
Century: By Ernest Caulfield, M. S., M. D., 
with a Foreword by Dr. G. F. Still. New 
York, Paul B. Hoeber, Inc. 1931. pp. 203. 

This is a well written volume, in narrative 
form, which covers the important events of the 
infant welfare movement in London during the 
eighteenth century. 

The book is particularly interesting, due pri- 
marily to the fact that it covers the peak in the 
dark ages of pediatrics and the descent of en- 
lightenment begins. The manifest indifference, 
cruelty and unconcern towards children, as re- 
vealed by this story, is barely believable, even 
though the time was two hundred years ago. 
Casting off the shackles of such an attitude that 
was due to ignorance required the concerted 
action of great men. The call was ably answered 
by such men as Coram, Cadogan, Hanway and 
Armstrong. 

I can heartily recommend this book to any one 
interested in the evolution that has taken place, 
or should we say the revolution that took place 
in eighteenth century pediatrics of London. It 
would be a valuable book to any one making a 
comparative study of the transition that has come 
about in infant welfare work. 

C. T. Williams, M. D. 


Eye, Ear, Nose and Throat for Nurses: By 

Jay G. Roberts, Ph. G., M. D., F. A. C. S. 
Philadelphia, F. A. Davis Co. 1931. pp. 213. 

This is a useful little book for the nurse to 
refer to for general information about the eye, 
ear, nose and throat. The illustrations are val- 
uable for familiarizing the nurse with instru- 
ments used in this surgical specialty. 

The author advises the use of chloroform anes- 
thesia for tracheotomy in children. This is at 
variance with the general opinion which demands 
local anesthesia in any patient so dyspneic as to 
be using his accessory (voluntary) muscles of 
respiration. Obviously, if these are paralyzed by 
a general anesthetic the result is disastrous. 

H. Kearney, M. D. 


Book Reviews 


225 


Manual of p Surgery : By Alexander Miles, M. D., 
LL. D., F. R. C. S., Ed., and D. P. D. Wilkie, 
M. D., F. R. C. S., Ed. and Eng-. V. 1. 8th 
ed. London, Oxford Univ. Press. 1931. pp. 
574. 

The eighth edition of this book, comprising 
over five hundred pages of reading matter and 
one hundred seventy-six illustrations, besides 
presenting the present day status of surgery, 
reflects the teaching of the Edinburgh School. 

Twenty-one collaborators, each dealing with 
subjects in which they are specially interested, 
have contributed to this manual. 

This book is not only valuable for the student, 
but makes a ready reference for the busy prac- 
titioner. 

Paul G. Lacroix, M. D. 


An Introduction to Gynecology : By C. Jeff Miller, 
M. D. St. Louis, The C. V. Mosby Company. 
1931. 117 illust. pp. 327. 

Here is a scholarly exposition of the funda- 
mentals of gynecology. Intended for beginning 
students, the book does not consider therapy. 
The author arranges the subject matter in six- 
teen chapters to conform with the sixteen week 
course in junior gynecology at the T'ulane School 
of Medicine. A concise section on the anatomy 
and physiology of the pelvic structures is followed 
by a very valuable consideration of the endocrine 
glands in relation to gynecology. The author 
then deals with the methods of examination and 
diagnosis. Three chapters are devoted to inflam- 
matory conditions, and one chapter each to 
obstetric injuries and malpositions of the uterus. 
Tumors are discussed in five chapters and the 
last three sections are devoted to functional dis- 
orders: dysmenorrhea, sterility, irregularities of 
the menstrual flow, and ectopic pregnancy. 

The book is splendidly written. It needs must 
be read. Each paragraph fairly bristles with 
facts, and, furthermore, each statement carries 
within itself the parenchyma of convincement 
fostered by twenty-five years of close clinical 
observation and study. 

It is a pity that some of the figures selected 
to illustrate the subject matter are not worthy 


of the text they accompany. That, however, is 
a* minor fault which need not deter the student 
from reading this masterly compilation of the 
essentials of gynecology. 

Charles Midlo, M. D. 


Lehrbuch und Atlas der Spaltlampenmikroskopie 
des Lebenden Auges: Text Book and Atlas 

of Slit-Light Microscopy of the Living Eye: 
Alfred Vogt. 2nd Ed. Vol, 1, Technique 
and Methods, Cornea and Anterior Chamber. 
692 illus. Berlin, Julius Springer. 1931. 
pp. 313. 

While reviewing this and other recent German 
ophthalmic books, a rather odd thought has re- 
peatedly occurred to me. The Germans are ap- 
parently trying hard to make theirs’ the world’s 
scientific written language, at least in ophthal- 
mology. Furthermore, they are apparently forc- 
ing a new type of book on those who keep pace 
with international ophthalmic progress, and at 
an almost prohibitive price. For example, this 
is one of a three volume series, costing, approx- 
imately, , $50 per volume. Several other recent 
volumes have appeared at prices ranging from 
$35 to $65 per volume. Needless to add, these 
books are not published in other languages. The 
thoroughness of the text, the completeness of the 
bibliography, and the remarkable quantity and 
quality of illustrations make these volumes indis- 
pensible, however, to the German reading ophthal- 
mologist, even though the cost is plainly exor- 
bitant. 

This second edition in three volumes is written 
around the first one volume edition which ap- 
peared some ten years ago. 

The principles and construction of the Zeiss 
lamp are very clearly and minutely explained. 
Naturally, we Americans feel that our Bausch & 
Lomb instrument, which is equally as good, should 
have been also described. The methods and 
technic, including various forms of illumination 
and observation, as well as the objective findings 
most frequently encountered, are then discussed 
in some thirty-five pages. 

The normal cornea with especial reference to 
its anatomic details as seen with the slit lamp, 


2*26 


Book Reviews 


is described and pictured in a most detailed and 
artistic manner, as are senile changes and the 
various degenerations. 

The anterior ocular findings associated with 
pseudo sclerosis as presented, are both new and 
interesting. 

Almost one hundred pages and two hundred 
illustrations are devoted to inflammatory corneal 
affections as seen with the slit light. 

Injuries, non traumatic tears of Descemet’s 
membrane, also folds, blood staining, and affec- 
tions of undetermined origin are then discussed. 

Lastly, the anterior chamber is described with 
its various affections. 

The literature references, numbering about two 
hundred and fifty, are quite well arranged, as is 
the excellent index and table of contents. 

To the ophthalmologist who reads German, this 
outstanding volume with its remarkable illustra- 
tions, is of great service in the better under- 
standing of slit-light microscopy which has 
changed so many of our conceptions in ocular 
pathology. 

Chas. A. Bahn,’ M. D. 


A Clinical Study of Addison’s Disease: By Leon 
G. Rowntree, M. D., and Albert M. Snell, 
M. D. Philadelphia, W. B. Saunders Com- 
pany. 1931. pp. 317. 

This study of Addison’s disease should be read 
by all physicians and students interested in 
this disease. One of the many commend 
able features of this little book is the original 
description of the disease by Addison in 1855, a 
most inspiring article. The pathologic physiology 
of the suprarenal glands in Addison’s disease is 
clearly presented, and clinical records of 65 cases 
described. 

Perhaps of greatest importance to the prac- 
titioner is the section on treatment. We are all 
familiar with the Muirhead treatment, which 
was the most efficient method up to the time of 
the preparation of an aqueous extract of the supra- 
renal cortex by iSwingle and Pfiffner in March, 
1930. Rowntree and Snell give the records of 
nine cases treated with this new extract which 


is not yet on the market. While the authors 
are rightly modest in regard to results obtained 
by the use of this extract, it would appear that 
another very important discovery had been made 
in substitution therapy, one comparable to insulin 
in diabetes, except that the Addisonian patient 
generally has a tuberculous condition to contend 
with as well as a lack of cortical hormone. Never- 
theless, if he can be tided over his exacerbations 
by this extract, his chance against the tuberculous 
infection is greatly enhanced. It is devoutly to 
be hoped that the long awaited cortical hormone is 
at hand. Randolph Lyons, M. D. 


PUBLICATIONS RECEIVED. 

Oxford University Press, New York: Diseases 
of the Gums and Oral Mucous Membrane, by Sir 
Kenneth Goadby, K. B. E., M. R. C. S., L. R. C. P., 
D. P. H., Fourth Edition. Encephalitis Lethargica 
Its Sequelae and Treatment, by Constantin von 
Economo. The Causation of Chronic Gastro- 
Duodenal Ulcers a New Theory, by J. Jacques ji 
Spira, M. R. C. S., L. R. C. P. (Lond.). 

P. Blakiston’s Son & Co., Inc., Philadelphia !■ 
Medical Jurisprudence, by Carl Scheffel, Ph. B., 
M. D., LL.B. Gould’s Medical Dictionary, by ! 
George M. Gould, A. M., M. D. 

The Midwest Company^ Minneapolis: What ( 

the Public Should Know About Childbirth, by j 
Walter Bourne Gossett, M. D. 

Thacker, Spink & Co., Calcutta: Indian Medi- jj 

cal Research Memories, by R. Knowles, I. M. S. 

Thacker’s Press & Directories, Ltd., Calcutta: ' 
Calcutta School of Tropical Medicine and Hygiene 
for the Year 1930, Appendix B., Calcutta School ! 
of Tropical Medicine and Hygiene for the Year | 
1930, Appendix A. 

Bengal Government Press, Calcutta: Annual i 

Report of the Calcutta School of Tropical Medi- 1 
cine Institute of Hygiene and the Carmichael Hos- ] 
pital for Tropical Diseases, 1930. 

The Century Co., New York: Pediatric Edu- j 

cation. 

Librairie Felix Alcan, Paris: Centrotherapie 

et Asuerotherapie, by Mme. E. Pierre Bonnier, ; 
M. D. 


New Orleans Medical 

and 

Surgical Journal 

Vol. 84 OCTOBER, 1931 No. 4 


STATE MEDICINE.* 

ANNUAL ORATION. 

JAMES B. BULLITT, M. D., 

Chapel Hill, North Carolina. 

I have selected as my topic the gravest 
social problem that confronts our profes- 
sion today. At every gathering of doctors 
the question of State Medicine casts its 
menacing shadow across the threshold of 
their thoughts. This is a day of unrest. 
The medical press is full of apprehension; 
the lay press is flooded with criticism. We 
look back on a Golden Age when the family 
physician was the trusted counsellor, the 
best friend of all his community; and we 
look ahead at the gathering clouds of a 
storm that threatens to sweep away the 
private practice of our profession. Are the 
complaints mere growing pains, or are 
they the obstetric throes that will usher in 
a new order? We have a long and honored 
past. What shall be our future? 

The thoughtless optimist may say, “God’s 
in His Heaven, all’s right with the world,” 
but this does not absolve us of the obliga- 
tion to recognize the problem and seek its 
solution. If we resent discussion of the 
matter, the fault must lie in us. Time does 
not permit, at this moment, a discussion of 
all the details, but we may consider the 
fundamentals. If our consciences are clear, 
we may face the situation fearlessly and 


*Annual Oration. Presented before the Public 
Meeting at the Sixty-fourth Annual Session of 
the Mississippi State Medical Association, Jack- 
son, May 12, 1931. 


without prejudice, and we may begin with 
the slogan, “The patient’s rights are para- 
mount”; for the doctor is ordained for the 
patient, not the patient for the doctor. Too 
often we are prone to think of him as our 
private property. 

The indictments against us may be sum- 
marized under two counts: (1) inadequate 
service, and (2) excessive costs. We reply 
that (1) medical service is better today 
than ever in the past, and that (2) the 
doctor’s compensation is inadequate, not 
comparable to the returns in other spheres 
of human endeavor. Here we have a para- 
dox. Both the charges are true, and our 
defense is equally true. 

The history of medicine shows a slow 
development. In the evolution of the prim- 
itive witch doctor into the present man of 
science, we find long eras of stagnation, 
alternating with brief but brilliant periods 
of advance. Medicine was conceived and 
born in the ancient caves of darkness and 
superstition; it spent a long infancy in 
swaddling clothes of magic and mysticism ; 
it passed through the vicissitudes of child- 
hood and adolescence in parti-colored gar- 
ments of empiricism and alchemy; today, 
in its young maturity, it clings to some of 
the toys and baubles of early years and 
sometimes masquerades in its discarded 
habiliments, but for the most part it wears 
the sober dress of modern science.. We are 
passing today through the most brilliant 
of all our periods of progress. It is com- 
mon knowledge that the past century has 
added more to scientific medicine than all 


228 


Bullitt — State Medicine; Annual Oration 


the accumulation of previous ages. Our 
recent graduates have a stock of scientific 
lore far beyond that of the leaders in the 
past; when to this is added mature ex- 
perience, our service to our patients is far 
superior to the best of former days. 

If this be true, then why the charge of 
inadequate service? It is because efficiency 
and cost are inextricably entangled. The 
highest quality of service exists, but it is 
not available to all. It is the old puzzle of 
supply, demand and distribution. The de- 
mand is large, the supply is insufficient, the 
distribution is imperfect. The problem was 
simple when one man could carry all the 
necessary equipment under his hat and in 
his hand bag; but the complexities of mod- 
ern practice require hospitals and labora- 
tories and much elaborate and expensive 
paraphernalia. Moreover, the vastness of 
the intellectual field and the limitations of 
the human mind make specialism a neces- 
sity. In this complicated situation costs 
mount high and imperfections multiply. 

Here in the bosom of the family we may 
with propriety speak freely of our faults. 
The very fields of science which we so care- 
fuly culture and of which we so proudly 
boast are fringed with weeds, and tares and 
mingled with the grain. We may speak 
properly of scientific medicine, but medi- 
cine is not and can never be a science. It is 
a highly complicated art, using all the 
sciences as tools; he who attempts to prac- 
tice it solely as an art is a fakir, and he 
who practices it solely as a science is a fool 
and a failure. We need not dwell upon the 
occasional charlatan in our midst; he is 
unimportant in the problem under consid- 
eration. But in this day of scientific preci- 
sion, honest practitioners often neglect the 
art of medcine ; they tend to become 
mechanized, to “substitute glassware for 
brains,” to subordinate keen observation 
and clear clinical thinking to laboratory 
tests and to mere records of instruments. 

We specialize too much; too early and 
too narrowly. None would decry the won- 


derful achievements of the specialties. They 
are choice grafts upon the parent medical 
tree, and they yield a luscious fruit; but 
they require careful selection and judicious 
pruning. They must not bear too early 
nor grow too rankly, and their number 
must be limited, lest they sap the life of 
the root that gives them sustenance. The 
well trained general practitioner can do 
all that is necessary to diagnose and treat 
over 95 per cent of our cases. If he can 
not make the simpler laboratory tests and 
do much of the simpler clinical work that 
now goes to specialists, he is not competent 
to practice medicine at all. Only the more 
complicated matters should be referred. 
These constitute but a small percentage of 
illnesses; yet about one third of our doc- 
tors call themselves specialists, because the 
financial returns are better and because the 
life is less strenuous. It is not entirely a 
joke when it is said that a specialist is 
“one who has his patients trained to be- 
come ill only in office hours, while a gen- 
eral practitioner is likely to be called off 
the golf course at any time.” How often 
do we see a youngster, fresh from medical 
school, with only a brief hospital service, 
announcing himself as a surgeon, an in- 
ternist, an endocrinologist or what not — 
a status that should be attained only after 
ripe clinical experience. Such a specialist, 
lacking a broad medical background, de- 
velops a spirit of arrogant self-assurance, 
but fails to attain the true heights of 
efficiency. This reacts upon the general 
practitioner who often develops an inferi- 
ority complex, and, both to his own and to 
his patient’s detriment, “parcels him out” 
to half a dozen confreres. This tends to 
destroy the intimate personal relation be- 
tween doctor and patient that has so high 
a psychic value in therapeusis, and it 
rouses in the patient a just resentment at 
the added expense. Truly, “money is the 
root of all evil.” 

We hospitalize many patients needlessly. 
The facilities for diagnosis of obscure con- 
ditions and for treatment of many severe 


Bullitt — State Medicine; Annual Oration 


229 


illnesses can be obtained better, or more 
cheaply, in hospitals than in most private 
homes; but only too often, in subjecting 
patients to hospital expense, we are con- 
sulting our own convenience rather than 
the needs of the case. 

There are some whose days of study 
cease early in their careers. They attend 
no medical meetings, they do not visit hos- 
pitals and clinics, their books are out of 
date, their journals are the advertising 
manuals of drug manufacturers. The cause 
may be indolence or indifference or pov- 
erty, but the results are the same. 

These are some of our faults. We do 
things that we ought not to do, and we 
leave undone things that we ought to do; 
nevertheless, though our health may be 
impaired, there is still vigor in us. Most 
of us are not content with placebos. We 
are ready to study the symptoms and ap- 
ply the remedy, thought it be drastic med- 
ication or radical surgery. We are striving 
earnestly to improve our service, and suc- 
cess will surely crown our efforts. 

It is not our professional failures, how- 
ever, that form the chief basis for the 
present discontent. The public is not 
stirred so much by our inefficiencies as by 
the high cost of illness, and we are less 
worried by our own imperfections than by 
our inadequate rewards. 

Our lives are bound in close communion 
with those of our fellow citizens. We live 
in an intricate maze of antagonistic rights 
and interests. Civilization is built upon a 
curious mixture of selfishness, generosity 
and cooperation. Without the driving 
energy of self interest, we should s